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Aetna Announces Intent to Collect Employee Counts from Plan Sponsors

Apr 29, 2011

Employee Count Data Collection
The federal health care reform law (Affordable Care Act or ACA) set new medical loss ratio rules and requires that insurers report the percentage of premium dollars spent on medical care and quality improvement activities. These reports must be filed annually, and will be calculated differently for plans that are considered Small Group (less than 101 employees) and Large Group (more than 100 employees). 
 
We need to include plan sponsors in the correct group so that the proper reporting and medical loss ratio is applied to their plans. To do this, we must obtain their average number of employees, beginning with calendar year 2010 and annually thereafter. We will ask customers for this information every year and are requesting the 2010 information now. 
 
How we will collect employee data
We will send a letter to plan sponsors that had fewer than two hundred medical plan enrollees in 2010 and ask them to report the average number of employees that worked for them in 2010. We will use this data to categorize the plan sponsor as either Small Group or Large Group.
 
Plan sponsors will submit data in one of three ways:
 
How to calculate the number of employees
The law defines the number of employees as "the average number of employees employed by the employer's company during the preceding calendar year." An employee is defined as any person for whom the company issues a W-2, including full-time, part-time, and seasonal workers, and regardless of insurance eligibility (sample calculation below). We need the average number of total employees for customers in 2010 to support the 2011 calculations and reports.
 
Below is an example of how to calculate the average number of employees*.
To calculate the average number of employees, determine the average number of employees for each month, then divide by twelve. In the example below, 253 / 12=21. Round up or down to the nearest whole number.

 

 
Month
Jan
Feb
Mar
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Average
Full Time
15
14
14
15
14
15
16
16
15
14
14
14
 
Part Time
5
6
5
5
6
6
7
7
5
5
5
5
Seasonal
0
0
0
0
0
2
3
3
2
0
0
0
Total
20
20
19
20
20
23
26
26
22
19
19
19
21
 
*Subject to change based on future regulatory guidance.

 

Thank you,

Aetna

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