Code of Massachusetts Regulations
956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY
Title 956 CMR 9.00 - Employer Surcharge For State Funded Health Costs
Section 9.04 - Determination of Surcharge Amount
Current through Register 1531, September 27, 2024
(1) General. The Connector will determine the Surcharge amount by taking into account:
(2) Employer Category.
Category 1 11-25 Employees
Category 2 26-50 Employees
Category 3 >50 Employees
(3) Assessment Percentage. The Connector will determine the percentage of State funded Health Costs to be assessed in accordance with the Table in 956 CMR 9.04(4). The percentages in the Table are based on the number of Employees and the amount of State-fund Health Costs incurred.
(4) Surcharge Determination. The Connector will apply the surcharge in the chart below to an Employer's State funded Health Costs when one State Funded Employee or his or her Dependents has four or more admissions or visits during the year, or its State Funded Employees and/or their Dependents have five or more visits during the year.
The product of the State Funded Health Costs and the applicable percentage will be reduced by the Employer's percentage of Enrolled Employees as determined under 956 CMR 11.03(1): General. However, in no case shall the reduction be greater than 75%.
State Funded Costs |
11-25 Employees |
26-50 Employees |
>50 Employees |
$50,000-$75,000 |
20% |
50% |
80% |
$75,001-$150,000 |
30% |
60% |
90% |
Over $150,000 |
40% |
70% |
100% |