What is a "Risk Adjustment Factor (RAF)?"

Small group health insurance companies use a Risk Adjustment Factor (RAF) to assess and issue a group's monthly insurance premium. In California, for example, all small group health insurance companies must establish and publish a Standard Rate with the State of California. Standard Rates have a RAF of 1.00. By California law, a health insurance company is limited to issuing a small group employer (generally 2-50 employees) a rate no more than 10% below (0.90 RAF) or 10% above (1.10 RAF) their Standard Rate. Group size, pre-existing medical conditions and the number of COBRA enrollees may affect a group's RAF in California. Outside of California, RAFs vary by health insurance company. If you have any questions regarding your rate or RAF, please feel free to contact our Customer Care Center Mon - Fri, 6AM-5PM PT at 800-872-1458 or via email.