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2-50: Anthem Issues MLR Rebate

Aug 21, 2013

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, 2013, we filed the required medical loss ratio report for the 2012 calendar year. 

We met the required loss ratio in the large group, small group, and individual markets for the California Department of Insurance. Additionally, the large group and individual markets for the Department of Managed Health Care met the required loss ratio, but the small group market did not. 

Rebate Check and Notification Schedule for California Small Groups

To make sure our small group customers understand why they’re receiving rebate checks, who receives them and when the checks will be sent, we are sending pre-rebate notifications to impacted group employers and Cal-Cobra subscribers in the near future. Attached is a sample of the small group employer letter that is being mailed. A subscriber report is also being created to assist in determining which subscribers are eligible for the rebate. All rebate checks and notices will be sent before August 1, 2013. 

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 2012 calendar year. View this fact sheet for more details and FAQs. Also, visit anthem.com/ca/healthcarereform for a tool to help employers calculate how much to send each employee if they received rebates and all other health care reform needs.

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