Rating pools are no strangers to Mountain State Blue Cross Blue Shield. We have had rating pools since inception of the Blues. The State of West Virginia has reformed the small group (2-50 enrolled) market. Therefore, the 2-50 market is pooled and a rate is developed based on the experience and expected risk. We start with a base rate and then adjust on the group's area, age, gender and industry factors. Pooling the small group market allows Mountain State to be within state defined limits and applying group factors allows proper rating based on each group's demographics.

Pooling is used on the 50+ groups in the form of credibility. They are rated, based in part, on their own experience and the Mountain State pool. The larger the group gets, we use more of the group's experience and less of the pool's experience. The group's experience usually becomes more credible.

Rating pools are not used on self-funded accounts.

Back