News & Updates
The Affordable Care Act (health care reform law) requires health plans to meet a minimum medical loss ratio, which varies according to market. Health insurance issuers must meet a minimum medical loss ratio of 85% in the fully insured large group market and 80% in the fully insured small group and individual markets.
The health care reform law also requires health plans to file a medical loss ratio report each year with the Department of Health and Human Services. On June 1, 2014, Anthem filed the required medical loss ratio report for the 2013 calendar year.
Anthem met the required loss ratio in the Large Group, Small Group, and Individual markets for the California Department of Insurance (CDI). Additionally, the Large Group and Individual markets for the Department of Managed Health Care (DMHC) met the required loss ratio, but the Small Group market for the DMHC did not.
Rebate Check and Notification Schedule for California Small Groups
To make sure Anthem's Small Group customers understand why they’re receiving rebate checks, who receives them and when the checks will be sent, Anthem is sending pre-rebate notifications to impacted group employers and Cal-Cobra members in the near future. Here is a sample of the small group employer letter being mailed. An enrollee report is also being created to assist in determine which enrollees are eligible for the rebate. All rebate checks and notices will be sent before August 1, 2014.
Employers receiving rebates can use the rebates to:
As a reminder, medical loss ratio requirements do not apply in the ASO market and short-term medical insurance is excluded from rebates.
Medical loss ratio rebates will not affect broker commissions for the 2013 calendar year. For more details and a tool to help employers calculate how much to send each employee if they received rebates, please visit www.anthem.com/ca/healthcarereform. You can also view the questions and answer document if you have any other inquiries.
Also, please see the Incorrect SS# Format in MLR Rebates for important updates.
For assistance with MLR rebates, please contact a member of your b&p Sales Team - 888.722.3373.