SMALL BUSINESS GROUP DENVER/BOULDER AGE-BANDED RATES* Effective April 1, 2008
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1 SMALL BUSINESS GROUP DENVER/BOULDER AGE-BANDED RATES* Effective April 1, Classic 15 HMO & 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Classic 30 HMO & 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Classic 35A HMO & 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Classic 20 HMO & 0-24 $ $ $665.6 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Classic 35 HMO & 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Classic 40 HMO & 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ (continued)
2 Small Business Group Denver/Boulder -Banded Rates* Effective April 1, 2008 Page Ded/Co HMO 500D & 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $348.8 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Ded/Co HMO 750D & 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $280.8 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Ded/Co HMO 1200D & 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Ded/Co HMO 2000D 2008 Ded/Co HMO 2000F & 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ & 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
3 Small Business Group Denver/Boulder -Banded Rates* Effective April 1, 2008 Page Classic 20 HMO Plus 2008 Classic 30 HMO Plus & 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ & 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Classic 35A HMO Plus & 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Ded/Co HMO Plus 500D & 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Ded/Co HMO Plus 1200D & 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
4 Small Business Group Denver/Boulder -Banded Rates* Effective April 1, 2008 Page Standard HMO 2008 Basic HMO & & 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Ded/Co HSA 2000 & 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Ded/Co HSA 2500D & 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
5 Small Business Group Denver/Boulder -Banded Rates* Effective April 1, 2008 Page MultiChoice SM POS 750B & 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ MultiChoice SM POS 1000D & 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ MultiChoice SM POS 1500D & 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ MultiChoice SM POS 2000F & 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
6 Small Business Group Denver/Boulder -Banded Rates* Effective April 1, 2008 Page 6 Out-of-Area PPO Classic Plan Employe & e 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Out-of-Area PPO - Plan 1 (SP01) Employe & e 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Out-of-Area PPO - Plan 2 (SP02) & 0-24 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Out-of-Area PPO - Plan 3 (SP03) & 0-24 $ $ $ $ $ $ $ $ $369.4 $ $ $ $ $ $ $ $ $ $ $ $ $968.9 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Supplemental Rates do not apply to OOA PPO Plans *New quotes: Rates on an initial quote are based on the carrier s filed rate of 1.0 and the provided census. Sold rates may vary downward 25 percent, upon final enrollment based on claims experience, standard industrial classification, and health status. Final rates will be based on final enrollment, individual age of an employee, and family status. (HB 1164) All Groups: The minimum number of employer-determined eligible employees for calculating composite rates is 10, and all small employers with 10 or more employer-determined eligible employees are entitled to a choice of composite rates or four-tier family, age-banded rates, and have the right to see them calculated either or both ways. (Reg ) Composite groups will have composite supplemental rates as well. Rates are guaranteed for 12 months from the group s contract date. Rates are effective January 1, 2008, and subject to change. -banded rates do not apply to Medicare or Medicare eligible individuals. 65+ rates apply to working aged, non-medicare individuals only. A small employer may be subject to premium adjustments up to 35 percent, if the small employer has, at any time during the last 12 months, purchased health benefit coverage as a small employer that is either self-funded or insured through a health benefit plan that is not a small group plan; or has been discontinued because of nonpayment of premiums or fraud. (HB 1294) Please call Kaiser Permanente Sales Department ( ) to verify rates. 08-D-SBGABRates Apr 08
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