Section 9.04 - Determination of Surcharge Amount(1)General. The Connector will determine the Surcharge amount by taking into account:(a) the number of Employees of the Employer;(b) the number of admissions and visits for each State funded Employee;(c) the total State funded Health Services attributed to the Employer's State Funded Employees as determined under 956 CMR 9.03(4); and(d) the percentage of Employees for whom the Employer provides health insurance.(2)Employer Category.(a) The Connector will assign each Employer subject to surcharge to one of three categories as follows: Category 1 11-25 Employees
Category 2 26-50 Employees
Category 3 >50 Employees
(b) The Connector will determine the number of full time equivalent Employees using the best available data including data from the Department of Revenue and the Division of Unemployment Assistance.(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% |