Sep 07, 2022
Employers who sponsor a fully insured group health plan may be receiving a Medical Loss Ratio (MLR) rebate from their insurers. Self-insured medical benefit plans are not subject to these requirements.
Medical Loss Ratio Requirements for the 2021 plan year:
- IFP & Small Group: Carriers must spend no less than 80% of premium revenue on medical expenses.
- Large Group: Carriers must spend no less than 85% of premium revenue on medical expenses.
For any carrier that has exceeded MLR in a market segment, policyholders with members enrolled in affected plans will receive a refund by September 30, 2022.
| CARRIER | MLR RESULT | DESCRIPTION OF REBATE | REBATES | |||
|---|---|---|---|---|---|---|
| IFP | SMALL GROUP | LARGE GROUP | MAILED BY | SENT TO | ||
| Banner|Aetna | Met MLR | Met MLR | Exceeded MLR | Sept. 30 | Employer | |
| Blue Cross Blue Shield of Arizona | Met MLR | Exceeded MLR | Met MLR | Brokers should contact their BCBSAZ Sales Rep for MLR related questions. View the letters being sent to groups and members. | Sept. 30 | Employer |
| Cigna + Oscar | pending | - | - | - | ||
| Humana | Met MLR | Exceeded MLR | Exceeded MLR | Small portion of groups are eligible for a refund. Further details pending. | Sept. 30 | Employer |
| CARRIER* | MLR RESULT | DESCRIPTION OF REBATE | REBATES | |||
|---|---|---|---|---|---|---|
| IFP | SMALL GROUP | LARGE GROUP | MAILED BY | SENT TO | ||
| Aetna | Met MLR | Met MLR | Met MLR | No rebates will be issued. | - | - |
| Anthem Blue Cross | Met MLR | Exceeded MLR | Met MLR | Anthem MLR Broker Aide Employer MLR FAQs MLR Calculator |
Begins early September, complete by Sept. 30 | Employer |
| Blue Shield of California | Met MLR | Met MLR | Met MLR | No rebates will be issued. | - | - |
| Health Net | Met MLR | Exceeded MLR | Met MLR | For Small Group Plans:
|
Sept. 30 | Employer |
| Kaiser Permanente | Met MLR | Met MLR | Met MLR | No rebates will be issued. | - | - |
| Oscar | pending | - | - | - | ||
| Sharp Health Plan | Met MLR | Met MLR | Met MLR | No rebates will be issued. | - | - |
| Sutter Health Plus | Met MLR | Met MLR | Met MLR | No rebates will be issued. | - | - |
| UnitedHealthcare | Met MLR | Exceeded MLR | Exceeded MLR | Final Payout Report Employer/Broker MLR hotline: 1-866-802-8602 |
Sept. 30 | Employer |
| Western Health Advantage | Met MLR | Met MLR | Met MLR | No rebates will be issued. | - | - |
* The following carriers are not subject to MLR: CaliforniaChoice, Covered California, and MediExcel Health Plan. For Covered California and CaliforniaChoice, refer to the enrolled carrier for results.
| CARRIER | MLR RESULT | DESCRIPTION OF REBATE | REBATES | |||
|---|---|---|---|---|---|---|
| IFP | SMALL GROUP | LARGE GROUP | MAILED BY | SENT TO | ||
| Aetna MD, VA, DC |
pending | - | - | - | ||
| CareFirst BlueCross Blue Shield - CFMI MD |
Exceeded MLR | Exceeded MLR | Met MLR | Small Group Broker Services and Individual Broker Services: 888-285-8311 FAQs are also available online at Medical Loss Ratio - Frequently Asked Questions (carefirst.com) |
Mailing begins August 22, 2022 | Employer and Individual Subscribers |
| CareFirst BlueCross Blue Shield - GHMSI MD |
Exceeded MLR | Exceeded MLR | Met MLR | Small Group Broker Services and Individual Broker Services: 888-285-8311 FAQs are also available online at Medical Loss Ratio - Frequently Asked Questions (carefirst.com) |
Mailing begins August 22, 2022 | Employer and Individual Subscribers |
| CareFirst BlueCross Blue Shield - GHMSI VA |
Exceeded MLR | N/A | N/A | Small Group Broker Services and Individual Broker Services: 888-285-8311 FAQs are also available online at Medical Loss Ratio - Frequently Asked Questions (carefirst.com) |
Mailing begins August 22, 2022 | Individual Subscribers |
| CareFirst BlueCross Blue Shield - BlueChoice MD |
Exceeded MLR | Met MLR | Met MLR | Small Group Broker Services and Individual Broker Services: 888-285-8311 FAQs are also available online at Medical Loss Ratio - Frequently Asked Questions (carefirst.com) |
Mailing begins August 22, 2022 | Individual Subscribers |
| CareFirst BlueCross Blue Shield - BlueChoice VA |
Exceeded MLR | Met MLR | Exceeded MLR | Large Group Broker Services: 855-850-0937 Individual Broker Services: 888-285-8311 FAQs are also available online at Medical Loss Ratio - Frequently Asked Questions (carefirst.com) |
Mailing begins August 22, 2022 | Employer and Individual Subscribers |
| CareFirst BlueCross Blue Shield - BlueChoice DC |
Met MLR | Met MLR | Exceeded MLR | Large Group Broker Services: 855-850-0937 FAQs are also available online at Medical Loss Ratio - Frequently Asked Questions (carefirst.com) |
Mailing begins August 22, 2022 | Employer |
| CareFirst BlueCross Blue Shield - CFMI Individual Catastrophic MiniMed MD |
Exceeded MLR | Met MLR | Met MLR | Small Group Broker Services and Individual Broker Services: 888-285-8311 FAQs are also available online at Medical Loss Ratio - Frequently Asked Questions (carefirst.com) |
Mailing begins August 22, 2022 | Individual Subscribers |
Connecticut
| CARRIER | MLR RESULT | DESCRIPTION OF REBATE | REBATES | |||
|---|---|---|---|---|---|---|
| IFP | SMALL GROUP | LARGE GROUP | MAILED BY | SENT TO | ||
| Aetna CT, NY |
Met MLR | Met MLR | Met MLR | No rebates will be issued. | - | - |
| Anthem Connecticut |
Met MLR | Exceeded MLR | Met MLR | Anthem MLR Broker Aide Employer MLR FAQs MLR Calculator |
Begins early September, complete by Sept. 30 | Employer |
| EmblemHealth | Met MLR | Met MLR | Met MLR | No rebates will be issued. | - | - |
| Empire | Exceeded MLR | Exceeded MLR | Met MLR | Empire Announcement Upstate Empire MLR Broker Aide Downstate Empire MLR Broker Aide |
Begins early September, complete by Sept. 30 | Employer |
| Harvard Pilgrim Maine |
Exceeded MLR | Met MLR | Met MLR | Harvard Pilgrim will be issuing premium credits on the October invoice for active accounts. For terminated individuals, checks will be mailed. MLR FAQ |
Sept. 30 | Individual |
| Harvard Pilgrim New Hampshire |
Met MLR | Exceeded MLR | Met MLR | Harvard Pilgrim will be issuing premium credits on the October invoice for active accounts. For terminated individuals and employer groups, checks will be mailed MLR FAQ |
Sept. 30 (if paid by check) | Employer (if paid by check) |
| Healthfirst | Met MLR | Met MLR | Met MLR | No rebates will be issued. | - | - |
| Oscar New York |
- | Information not available. | - | - | ||
| Oxford | Met MLR | Met MLR | Met MLR | No rebates will be issued. | - | - |
| UnitedHealthcare Connecticut |
Met MLR | Met MLR | Met MLR | No rebates will be issued. | - | - |
| UnitedHealthcare New York |
Met MLR | Met MLR | Exceeded MLR | Final Payout Report Employer/Broker MLR hotline: 1-866-802-8602 |
Sept. 30 | Employer |
* The following carrier is not subject to MLR: HealthPass. Refer to the enrolled carrier for results.
Visit the CMS website to search historical MLR filings by carrier and year.
Employers should be aware that although employers are not required to send a specific notice regarding the rebate to employees, insurance carriers are required to send notices of rebates to plan participants. The notices sent by carriers will not include the amount of the rebate, but will state that the rebate was sent to the employer and that a portion may be distributed to participants.
Although there are no specific notice requirements for employers, it may be worthwhile to send an employee communication that clarifies whether, and how, employees can expect to receive their portion of the rebate. Employers may also want to point out that the rebate will usually be a relatively small amount on a per-participant basis. Employees may incorrectly assume that they will be receiving a significant rebate based on only the information included in the carrier notices.
Related Article: How Employers Should Handle MLR Rebates
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