Community rating

A method of establishing premiums for health insurance in which the premium is based on the average cost of actual or anticipated health care used by all subscribers in a specific geographic area or industry and does not vary for different groups or subgroups of subscribers or with such variables as the group’s claims experience, age, sex, or health status. The HMO Act (section 1302(8) of the PUS Act) defines community rating as a system of fixing rates of payments for health services which may be determined on a per person or per family basis “and may vary with the number of persons in a family, but must be equivalent for all individuals and for all families with similar composition.” The intent of community rating is to spread the cost of illness evenly over all subscribers (the whole community) rather than charging the sick more than the healthy for health insurance. Community rating is the exceptional means of establishing health insurance premiums in the Ignited States today. The Federal Employee’s Health Benefits Program for example is experience rated, not community rated.


 


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