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ACA News: MLR Surveys will go to Employers Soon

May 15, 2015

As part of the medical loss ratio (MLR) provision of the Affordable Care Act (ACA or health care reform law), health insurers must categorize employer groups as either small or large, based on the average number of full-time equivalent employees they have. As a reminder, the MLR provision applies to the amount of premium spent on medical care and quality improvement programs for members covered under fully insured group health care plans. 

Because Anthem has data only on how many are enrolled in health care plans, they need to survey employers for the average number of employees they had in 2014 to categorize them effectively as a Small or Large Group. This includes full-time, part-time and seasonal employees. This data is vital for Anthem to have, because they must meet different MLR thresholds for individual, Small group and Large Group markets.

The way a group is categorized could impact the rebate amount they get, if they get one. The data will be used only to categorize groups for the 2015 calendar year MLR reporting. If a group doesn’t respond, it will be categorized based on the current membership numbers Anthem has.

By the end of May, Anthem will start sending the survey to all of their fully insured, local group customers. For more details on the survey, read this ​fact sheet and Frequently Asked Questions (FAQ)

For questions, please ​contact a member of your b&p Sales Team - 888.722.3373.

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