Sep 30, 2023
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 2022 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 did not meet MLR in a market segment, policyholders with members enrolled in affected plans will receive a refund by September 30, 2023.
| CARRIER | MLR RESULT | DESCRIPTION OF REBATE | REBATES | |||
|---|---|---|---|---|---|---|
| IFP | SMALL GROUP | LARGE GROUP | MAILED BY | SENT TO | ||
| Banner|Aetna | Met MLR | Met MLR | MLR Not Met |
2022 MLR Experience Year Rebate Pools | Sept. 30 | Employer |
| Blue Cross Blue Shield of Arizona | Met MLR | MLR Not Met |
Met MLR | In the small group market, BCBSAZ spent only 78.3% of a total of $350,751,048 in premium dollars on health care and activities to improve health care quality. BCBSAZ must rebate 1.7% of the total health insurance premiums paid by impacted employer and employees. | Sept. 30 | Employer |
| Cigna + Oscar | - | Met MLR | - | No rebates will be issued. | - | - |
| Humana | - | Met MLR | Met MLR | No rebates will be issued. | - | - |
| 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 | MLR Not Met |
MLR Not Met |
Rebates due to HMO and PPO plans in the small group market, and PPO plans in the large group market. View the 2022 Broker Aide and Employer FAQs. |
Sept. 30 | Employer |
| Blue Shield of California | Met MLR | Met MLR | Met MLR | No rebates will be issued. | - | - |
| Cigna + Oscar | - | Met MLR | - | No rebates will be issued. | - | - |
| Health Net | Met MLR | Met MLR | Met MLR | No rebates will be issued. | - | - |
| Kaiser Permanente | Met MLR | Met MLR | Met MLR | No rebates will be issued. | - | - |
| 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 | - | MLR Not Met |
MLR Not Met |
The UHC 2023 Medical Loss Ratio Final Payout Report shows rebates are due for the following entities:
|
Mailing begins week of Sept. 18th. All rebates sent by 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 | Met MLR | MLR Not Met |
MLR Not Met |
Sept. 30 | Employer | |
| Florida Blue | Met MLR | Met MLR | Met MLR | No rebates will be issued. | - | - |
| CARRIER | MLR RESULT | DESCRIPTION OF REBATE | REBATES | |||
|---|---|---|---|---|---|---|
| IFP | SMALL GROUP | LARGE GROUP | MAILED BY | SENT TO | ||
| Aetna | Met MLR | Met MLR | MLR Not Met |
Sept. 30 | Employer | |
| Anthem Virginia |
MLR Not Met |
MLR Not Met |
MLR Not Met |
Rebates due to PPO plans in the small group market and HMO plans in the large group market. View the 2022 Broker Aide and Employer FAQs. | Sept. 30 | Employer |
| CareFirst BlueCross Blue Shield - CFMI Maryland |
Met MLR | MLR Not Met |
Met MLR | Rebates are due; details on eligible groups will be available through broker services 3 days prior to the expected mail date. View the MLR Rebate FAQs. | Begins Aug. 28; completed by Sept. 30 | Employer |
| CareFirst BlueCross Blue Shield - GHMSI Maryland |
MLR Not Met |
MLR Not Met |
Met MLR | Rebates are due; details on eligible groups will be available through broker services 3 days prior to the expected mail date. View the MLR Rebate FAQs. | Begins Aug. 28; completed by Sept. 30 | Employer |
| CareFirst BlueCross Blue Shield - GHMSI Virginia |
MLR Not Met |
Met MLR | Met MLR | Rebates are due; details on eligible groups will be available through broker services 3 days prior to the expected mail date. View the MLR Rebate FAQs. | Begins Aug. 28; completed by Sept. 30 | Employer |
| CareFirst BlueCross Blue Shield - BlueChoice Maryland |
Met MLR | Met MLR | Met MLR | No rebates will be issued. | - | - |
| CareFirst BlueCross Blue Shield - BlueChoice Virginia |
Met MLR | Met MLR | MLR Not Met |
Rebates are due; details on eligible groups will be available through broker services 3 days prior to the expected mail date. View the MLR Rebate FAQs. | Begins Aug. 28; completed by Sept. 30 | Employer |
| CareFirst BlueCross Blue Shield - BlueChoice District of Columbia |
Met MLR | Met MLR | Met MLR | No rebates will be issued. | - | - |
| CareFirst BlueCross Blue Shield - CFMI Individual Catastrophic MiniMed Maryland |
MLR Not Met |
- | - | Rebates are due; details on eligible groups will be available through broker services 3 days prior to the expected mail date. View the MLR Rebate FAQs. | Begins Aug. 28; completed by Sept. 30 | Employer |
| UnitedHealthcare District of Columbia |
- | Met MLR | Met MLR | No rebates will be issued. | - | - |
| UnitedHealthcare Maryland |
MLR Not Met |
Met MLR | MLR Not Met |
The UHC 2023 Medical Loss Ratio Final Payout Report shows rebates are due for the following entities:
|
Sept. 30 | Employer |
| UnitedHealthcare Virginia |
Met MLR | MLR Not Met |
MLR Not Met |
The UHC 2023 Medical Loss Ratio Final Payout Report shows rebates are due for the following entities:
|
Sept. 30 | Employer |
| CARRIER | MLR RESULT | DESCRIPTION OF REBATE | REBATES | |||
|---|---|---|---|---|---|---|
| IFP | SMALL GROUP | LARGE GROUP | MAILED BY | SENT TO | ||
| Aetna Connecticut, New York |
Met MLR | Met MLR | Met MLR | No rebates will be issued. | - | - |
| Anthem Connecticut |
Met MLR | MLR Not Met |
Met MLR | Rebates due to HMO and PPO plans in the small group market. View the 2022 Broker Aide and Employer FAQs. | Sept. 30 | Employer |
| Cigna + Oscar Connecticut |
pending | - | - | - | ||
| EmblemHealth | Carrier will not release results | - | - | - | ||
| Empire | Met MLR | Met MLR | Met MLR | No rebates will be issued. | - | - |
| Harvard Pilgrim Massachusetts |
MLR Not Met |
MLR Not Met |
Met MLR | In Massachusetts, HPHC Inc. did not meet MLR in all markets. In 2022, HPHC Inc. spent only 87.6% of a total of $ 411,849,103 in premium dollars on health care and activities to improve health care quality. HPHC Inc. must rebate 0.8% of the total health insurance premiums paid by impacted employers and employees. | Sept. 30 | Employer |
| Harvard Pilgrim Maine |
Met MLR | Met MLR | Met MLR | No rebates will be issued. | - | - |
| Harvard Pilgrim New Hampshire |
Met MLR | MLR Not Met |
Met MLR | In New Hampshire, HPHC Insurance Company, Inc. (HPHC) did not meet MLR in all markets. HPHC spent only 70.4% of a total of $20,472,951 in premium dollars on health care and activities to improve health care quality. HPHC must rebate 9.6% of the total health premiums paid by impacted employers and employees. | Sept. 30 | Employer |
| Healthfirst | Met MLR | Met MLR | Met MLR | No rebates will be issued. | - | - |
| Oscar New York |
pending | - | - | - | ||
| Oxford Connecticut |
- | Met MLR | Met MLR | No rebates will be issued. | - | - |
| Oxford New York |
- | Met MLR | MLR Not Met |
The UHC 2023 Medical Loss Ratio Final Payout Report shows rebates are due. | Sept. 30 | Employer |
| UnitedHealthcare Connecticut |
- | Met MLR | Met MLR | No rebates will be issued. | - | - |
| UnitedHealthcare New York |
- | MLR Not Met |
MLR Not Met |
The UHC 2023 Medical Loss Ratio Final Payout Report shows rebates are due. | 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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