A Tiered Network is one in which health care providers are arranged in “tiers” based on the value of care they provide. The value is based both on cost and quality of care.
Providers that deliver care that is high value (with lower cost and higher value) assigned the highest tier two ranking.
Ratings or Ratings Factors) are used by insurance companies to determine consumer health insurance premiums.
For coverage effective on or after January 1, 2014, insurers in the Individual and Family Plan (IFP) and Small Group markets are allowed to vary premiums based on geography, age (within a 3:1 ratio for adults), tobacco use (within a 1.5:1 ratio), and family size.
Forty-five states selected or defaulted to a Small Group plan, while chose
States can choose to enact stronger consumer protections than the minimum standards described above. In addition, they have the option to allow larger employers to purchase coverage through the Marketplace Exchanges.
The goal of market ratings reforms/adjusted community ratings/rating factors is to standardize how health insurers can price products – bringing a new level of transparency and fairness to pricing.