The categorization of employees depending on any enrollment of dependents. For example, employees who enroll only themselves occupy a different tier from employees who enroll themselves and a spouse.
Monthly premium equivalent rates
The amount budgeted to cover the estimated total eligible transactions made by your employees, including any administrative fees.
Total estimated annual plan cost
The projected total cost that you’ll pay to provide the benefit to your employees, assuming that enrollment remains the same for the full plan year. It is calculated by multiplying premium equivalent rates by expected enrollment. This estimate does not take into account employee contributions, which may lower total cost for the employer.
Total estimated member out-of-pocket cost
An estimate of the annual out-of-pocket cost that employees and their dependents can expect to pay, based on your selected plan design. This is calculated based on plan type, costs for items and services in the members’ geographic area, and typical utilization in that area. It accounts for any applicable deductible, copays, coinsurance, and the possibility that members will exceed their annual maximum.