Community rated definition

Community rated means a rating method in the large group market that bases rates on the expected costs to a health care service plan or health insurer for providing covered benefits to all enrollees or insureds, including both low-risk and high-risk enrollees or insureds. (H&SC § 1385.01(a)(2) & CIC § 10181(a)(2).) This is also commonly known as manually rated.
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Community rated means that the premium for all persons covered under a health benefits plan contract is the same, based on the experience of all persons covered by that contract, without regard to age, sex, health status, occupation and geographical location.
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Community rated means a rating method in the large group market that bases rates on the expected costs to a health care service plan of providing covered benefits to all enrollees, including both low-risk and high-risk enrollees. Premiums may vary according to the factors in this article.
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Examples of Community rated in a sentence

  • Administrative expenses and re- tentions, including capitated adminis- trative expenses and retentions.(b) Community rated carriers.

  • Administrative expenses and retentions, including capitated administrative expenses and retentions.(b) Community rated carriers.

  • Drivers shall receive their full pay rate for taking vehicles to repair facilities.

  • Community rated private insurance, including VHI and Australian systems, is less like wholly private finance because of the adjustment for premiums to prevent discrimination against sicker citizens.

  • Community rated products include a pricing structure for a single population, with different price points depending on age and location.

  • Community rated groups tend to have higher premiums.• Approximately 95 percent of employees are in a plan with an actuarial value of 80 percent or more.• Medical and pharmacy trends have seen double trend growth in the last decade.

  • Community rated states are New York, New Jersey, Massachusetts, Washington, Kentucky, and New Hampshire.

  • In her declaration, Ms. Kichak stated: Community rated health maintenance organizations are at risk when they determine their rates.

  • Effective July 1, 1983 and thereafter, the City’s cost for each employee and each retiree under age 65 coverage shall be equalized at the Community rated basic HIP/HMO plan payment rate as approved by the State Department of Insurance on a category basis of individual or family, e.g. the Blue Cross/ GHI-CBP payment for family coverage shall be equal to the HIP/ HMO payment for family coverage.

  • Community rated PMI markets all over the world are supported by robust risk sharing schemes that eliminate the incentive to compete on the basis of risk selection.


More Definitions of Community rated

Community rated means a rating method in the large group market that bases rates on the expected costs to a health insurer of providing covered benefits to all insureds, including both low-risk and high-risk insureds. Premiums may vary according to the factors in this article.
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Community rated means that premiums do not depend on your age, either at the time the policy is issued or upon renewal. Premiums depend on other factors and may increase because of benefit changes or overall premium adjustments.
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Community rated means a rating methodology in which the premium for all persons covered by a policy is the same based on the wages of the covered person and the experience of the entire pool of risks covered by family leave benefits coverage in the state by all issuers and self-funded employers without regard to utilizationor expected utilization of the family leave benefits or any factor that may correlate with such utilization including, without limitation, age, gender, health status or occupation.
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Community rated means a rating methodology in
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Community rated means that the risks of all insureds in a defined “community” are blended together to develop the premiums for health in- surance. A “community” is made up of all individuals having a particular insurance plan. Community rating spreads the cost of insurance evenly among all the individuals in a commu-
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Community rated means that the risks of all insured persons in a defined “community” are blended together to develop the premiums for health insurance. A “community” is made up of all individuals having a particular insurance plan in that market. Community rating spreads the cost of insurance evenly among all the individuals in a community with that plan, instead of charging significantly higher or lower costs for a person or group based on risk or claims experience. Vermont statutes require that each insurer set community rates in the small employer and non-group markets. Approximately 9.8% (35,030) of Vermonters in the privately insurance market (358,445) had community rated premiums in 2004 (Figure 6).
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Related to Community rated

  • Community rate means a rate of payment based on a per member per month capitation rate or its equivalent that applies to a combination of the subscriber groups for a comprehensive medical plan carrier. References in this subchapter to ‘‘a combination of cost and price analysis’’ relating to the ap- plicability of policy and contract clauses refer to comprehensive medical plan carriers using community rates.

  • Adjusted community rate means the rating method used to

  • Community basin means an infiltration system, sand filter designed to infiltrate, standard constructed wetland, or wet pond, established in accordance with N.J.A.C. 7:8-4.2(c)14, that is designed and constructed in accordance with the New Jersey Stormwater Best Management Practices Manual, or an alternate design, approved in accordance with N.J.A.C. 7:8-5.2(g), for an infiltration system, sand filter designed to infiltrate, standard constructed wetland, or wet pond and that complies with the requirements of this chapter.

  • Community restitution means compulsory service, without

  • community centre means any school, railway station, police station and other location providing a service to the community;

  • Community school means a community school established under Chapter 3314. of the Revised Code.

  • Community-based means a facility, program or service, or open group home or other suitable place located near the home or family of the juvenile, and programs of community supervision and service which maintain community participation in their planning, operation, and evaluation. These programs may include but are not limited to medical, educational, vocational, social, and psychological guidance, training, counseling, alcoholism treatment, drug treatment, diversion programs for first-time offenders, transitional living, independent living and other rehabilitative services;

  • Community-Wide Standard means the standard of conduct, maintenance, or other activity generally prevailing in the Community. Such standard may be more specifically determined by the Board of Directors of the Association. Such determination, however, must be consistent with the Community-Wide Standard originally established by the Declarant.

  • Community mental health center or "CMHC" means a facility offering a comprehensive array of community-based mental health services, including but not limited to, inpatient treatment, outpatient treatment, partial hospitalization, emergency care, consultation and education; and, certain services at the option of the center, including, but not limited to, prescreening, rehabilitation services, pre-care and aftercare, training programs, and research and evaluation.

  • Community protection zone means the area within eight

  • Community air carrier means an air carrier with a valid operating licence granted by a Member State in accordance with Council Regulation (EEC) No 2407/92 of 23 July 1992 of licensing of air carriers(7) ;

  • Community facilities means a specific work, or improvement within this state or a specific item of equipment or tangible personal property owned or operated by any political subdivision or nonprofit corporation and used within this state to provide any essential service to the general public;

  • Community location means a public or private elementary or secondary school, a church, a public library, a public playground, or a public park.

  • Community facility means community room, clubhouse, recreation center or similar area for use by residents. Lobbies and laundry facilities must not be considered within the scope of this definition.

  • Community service means compulsory service, without

  • Community services means any type of counseling and advice, emergency assistance, medical care,

  • Community health worker means an individual who:

  • Community water system means a public water system which serves at least 15 service connections used by year-round residents or regularly serves at least 25 year-round residents.

  • Community association means an association in which membership is a condition of ownership or shareholder interest of a unit in a condominium, cooperative, townhouse, villa, or other residential unit that is part of a residential development plan as a master association or common interest community and that is authorized to impose an assessment and other costs that may become a lien on the unit or lot.

  • Community mental health program means all mental health

  • New Jersey Stormwater Best Management Practices (BMP) Manual or “BMP Manual” means the manual maintained by the Department providing, in part, design specifications, removal rates, calculation methods, and soil testing procedures approved by the Department as being capable of contributing to the achievement of the stormwater management standards specified in this chapter. The BMP Manual is periodically amended by the Department as necessary to provide design specifications on additional best management practices and new information on already included practices reflecting the best available current information regarding the particular practice and the Department’s determination as to the ability of that best management practice to contribute to compliance with the standards contained in this chapter. Alternative stormwater management measures, removal rates, or calculation methods may be utilized, subject to any limitations specified in this chapter, provided the design engineer demonstrates to the municipality, in accordance with Section IV.F. of this ordinance and N.J.A.C. 7:8-5.2(g), that the proposed measure and its design will contribute to achievement of the design and performance standards established by this chapter.

  • Community setting means a location outside a hospital inpatient, acute care setting or a hospital clinic setting. A community setting may include, but is not limited to, a home, group home, assisted living facility, correctional facility, hospice, or long-term care facility.