How to read a carrier rate sheet
The rate sheet is one page and it is where most comparison errors start: a total mistaken for a tier rate, a member-rated quote beside a composite one, an expired effective date. Six checks, in the order to make them, before a number goes into the spreadsheet.
1. Find the rating basis
Composite rates give one premium per coverage tier for the whole group. Age-banded or member-level rates give a premium per person by age, and the carrier may show a composite equivalent beside them. Most ACA small-group plans are rated per member by age in most states; large-group and level-funded quotes usually come composite. Know which one you are holding before you compare it with anything.
2. Check the effective date and the rate guarantee
A rate sheet is only good for the effective date printed on it and the guarantee period after it, commonly twelve months. A quote that expires before the group's renewal date is not a quote. Note both dates in the comparison beside the rate.
3. Confirm the tier structure matches the census
Four tiers (employee, employee plus spouse, employee plus children, family) is the common structure; three tiers (employee, plus one, plus two or more) and five-tier variants exist. If the carrier's tiers do not match how the group's enrollment is recorded, employees will be priced into the wrong row. Map the census to the sheet's tiers before entering anything.
4. Read what the rate includes and excludes
Check whether the figure is monthly or per pay period, whether it is per employee or a total for the group, and whether anything is loaded into it: PEO administration fees, bundled ancillary lines, or a commission basis that differs from the current plan. A rate that looks lower because dental is no longer bundled is not lower.
5. Match every plan on the sheet to its SBC
Rate sheets name plans by marketing name or plan ID; SBCs use the same ID on page one. Match them so the deductible and copays in the comparison belong to the rate on the same row. A renewal packet often carries one more plan on the rate sheet than it has SBCs for, or the reverse.
6. Separate the rates from everything else on the page
Enrollment counts, monthly totals, year-over-year percentages, "illustrative" figures and anything marked subject to final enrollment or underwriting are not rates. Keep them out of the rate rows and record them separately if the client will ask. A comparison built on a total instead of a tier rate is wrong in every cell.
Level-funded rate sheets carry two more numbers
A level-funded quote shows a fixed monthly cost and, somewhere on the page or in the attached stop-loss terms, a maximum annual liability. The fixed cost is what the comparison usually picks up; the maximum is what the employer is actually exposed to. Stop-loss terms on a level-funded quote covers how to read the attachment points, and level-funded vs fully insured covers how to put that quote beside a premium.
Common questions
What is the difference between composite and age-banded rates?
Composite rates are one premium per coverage tier for everyone in the group. Age-banded or member-level rates charge each enrolled person by age, so the group total depends on who enrolls. Many small-group ACA quotes are member-rated with a composite equivalent shown for convenience; large-group and level-funded quotes are usually composite.
How long is a group health rate sheet valid?
For the effective date printed on it and the rate guarantee period that follows, which is commonly twelve months for a fully insured plan. Check both, and treat a quote whose effective date has passed as needing to be re-run.
Why do my census and the rate sheet use different tiers?
Carriers choose the tier structure; payroll and enrollment systems record whatever the previous plan used. Map each employee's current coverage to the new sheet's tiers before pricing, or the per-paycheck figures will be wrong for anyone who sits between the two structures.
Can I paste a rate sheet straight into a spreadsheet?
If the text can be selected, yes. The free rate sheet to spreadsheet converter reads the tiers, plan names and dollar amounts out of pasted text and lists anything it cannot place, so the enrollment counts and footnotes stay out of the rate rows.
Where to go next
Once the rates are clean, the rate sheet to spreadsheet converter moves a pasted table into a CSV, the employee benefit deduction calculator turns a tier rate and the employer contribution into the per-paycheck figure, and how to compare two health insurance quotes is the next step. For a whole renewal packet, quote and invoice analysis reads the rate sheet itself and flags what it is unsure of.