Community-rated quoting provides a simplified way to generate plan comparisons, but there are certain limitations and gaps in available data that users should be aware of. These blind spots occur due to restrictions from carriers, state-specific rating rules, and the availability of plan data.

Key Limitations

1. Blue Cross Blue Shield Data Limitations
2. • Blue Cross of Mississippi – Does not provide plan data.
   • Blue Cross of North Carolina – Does not provide plan data.
   • Blue Cross of Massachusetts – Only provides plans available on the Health Connector.
   • Florida Blue - Does not provide plan data. Data is occasionally pulled from public filings, but is commonly unavailable altogether.
3. UnitedHealthcare Variability
4. • UnitedHealthcare does not provide all plan data nationwide, and availability varies by state. If a plan is missing, users can enter it manually.
5. Composite Rates in Washington State
6. • Washington calculates composite rates differently from any other state, and Plansight does not support its unique calculation methods. However, all age-banded plans and rates are available.
7. Minimum Employee Requirements for Composite Rates
8. • Some carriers require a minimum number of enrolled employees before offering composite rates. If that threshold is not met, only age-banded rates will be available.

Workarounds for Missing Plans

If a plan is missing due to one of these blind spots, users can manually enter it using one of the following methods:

• Using the SBC (Summary of Benefits and Coverage): If you have an SBC, you can create a standard quote and input rates manually.
• Using the Plan Library: If the plan design is available in your saved library, you can select it and enter the required rates.

Entering Rates

• Age-Banded Plans: Enter rates manually for each age band.
• Composite Plans: If you have composite rates, you can enter them just as you would for any other quote.

How the Community-Rated Engine Works

Our community-rated system is a rating engine , which depends on well-formatted data to return accurate results. Data comes from one of two primary sources:

1. Direct Carrier Feeds – UnitedHealthcare is the only carrier that provides plans and rates directly to our system. Other carriers supply data in designated data packets rather than through direct system integrations. This information goes through a quality assurance process , ensuring it is correctly formatted and accurate before being made available for quoting.
2. State Filings – In cases where direct carrier data is unavailable, rates and benefits are gathered from state filings. This involves collecting SBCs, business rules, rate sheets, and benefit details , running them through quality checks, and ensuring they align correctly within the rating engine.

It’s important to note that carriers post their rates on their own websites first, as they are the originating source of the data. There may be a slight lag between when a rate is available on a carrier’s website and when it appears in our system, due to the necessary quality assurance and formatting process.

The key advantage of using Plansight’s rating engine is that you can quote multiple plans from multiple carriers side by side in a single interface . Instead of logging into individual carrier portals and manually compiling rates in spreadsheets, our system ensures that all plan details are formatted consistently, allowing for easy comparisons.

Conclusion

While community-rated quoting offers a streamlined experience, these blind spots may impact certain carrier plans and states. By understanding where these gaps exist and utilizing manual entry methods, users can ensure they have a complete and accurate quote comparison. For additional guidance, check out our video tutorials on entering plans and rates manually.