Important News for Blue Shield and Anthem Blue Cross Small Business Clients!

by | Aug 10, 2020 | Employee Benefits

Small Group Carriers Anthem Blue Cross and Blue Shield have announced they will have a medical loss ratio (MLR) rebate this year for the 2019 coverage period.  Currently, Kaiser Permanente is saying they will not be issuing an MLR rebate this year.  Health Net and United Healthcare have not yet issued their statements on this topic.

Reminder, what is MLR?  The medical loss ratio provision of the Affordable Care Act (ACA) encourages health plans to spend most of the premium dollars they collect on health care costs rather than overhead. It’s a ratio of insurance claims costs to insurance premiums, and is expressed as a percentage.

In the Fully Insured Small Group and Individual markets, the MLR provision requires plans to spend at least 80% of premium income on health care claims and quality improvement.

Anthem Blue Cross and Blue Shield will send rebate checks to employer groups along with a federally mandated notice that explains MLR and how it is calculated. They are also mandated to notify employees of the groups that receive rebate checks.

ACA rules require that employers either distribute the rebate among their employees covered by the rebated plan, or use it to lower premiums in the next plan year. Rebate distributions must be made within three months of the policyholder’s receipt of the rebate. Group plans that are subject to Employee Retirement Income Security Act (ERISA) laws may also use the rebate funds to pay current plan premiums.

Be sure to view the FAQ (.PDF) as well as the Rebate CalculatorFor more information contact your United Agencies Representative. We are happy to be of service.

You may also visit Anthem’s COVID page here.

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