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Changes to the Age Rating Bands for 2018 Plans

September 21, 2017

Applies to:Individual and Small Group markets

Due to the 2018 Notice of Benefits and Payment Parameters (NBPP) released by the U.S. Department of Health and Human Services (HHS), Horizon Blue Cross Blue Shield of New Jersey will implement new age bands for members in the Individual and Small Group medical markets. The new age bands better reflect the changes in health risks as individuals get older and provides a more gradual increase in premium rates to better manage the impact on consumers.

To make it easier for our members, Horizon BCBSNJ will also apply the new age bands to our stand-alone pediatric dental (SAPD) plans, such as Horizon Young Grins.

The new age bands are as follows:

  1. Children:
  • For both medical and SAPD plans (dental plans that provide pediatric dental coverage), a single age band for children –
  • Ages 0 through 14
  • For medical, one-year age bands for individuals –
  • Age 15
  • Age 16
  • Age 17
  • Age 18
  • Age 19
  • Age 20
  • For SAPD plans, one-year age bands for individuals –
  • Age 15
  • Age 16
  • Age 17
  • Age 18
  1. Adults:
  • For the Small Group Horizon Family Grins plans, the age bands have been restructured to conform to the age bands of the Small Group Horizon Family Grins Plus plans –
  • Ages 19 through 22
  • Ages 23 through 24
  • Ages 25 through 29
  • Ages 30 through 34
  • Ages 35 through 39
  • Ages 40 through 44
  • Ages 45 through 49
  • Ages 50 through 54
  • Ages 55 through 59
  • Ages 60 through 63
  • Ages 64 and older
  • For both the Individual market and Small Group Horizon Family Grins Plus, the upper age band for the senior population will change to 64 years and older. This means all individuals ages 64 years and older will be rated the same.

No changes to three-child cap rating rule

Horizon BCBSNJ will not change the current rating rules for calculating family premiums for households with more than three dependent children. This means:

  • Only the three eldest children will be rated. Additional dependent children will not be charged for medical or SAPD coverage.

Effective date

The age band changes will be effective:

  • January 1, 2018 for Individual and new Small Group customers
  • Upon 2018 renewal date for existing Small Group customers

If you have questions, please contact your Horizon BCBSNJ sales executive or account manager.

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Published on: September 27, 2017, 03:10 a.m. ET
Last updated on: April 26, 2021, 01:31 a.m. ET