The Minimum Medical Loss Ratio (MLR) provision of the Affordable Care Act sets minimum percentages that health plans must spend on medical costs and quality improvement activities. Insurers file reports with the federal government detailing where they met the minimum, where they didn't, and how much they will pay their insured customers in rebates.
Aetna, InnovationHealth and Texas Health | Aetna plans are scheduled to receive rebates under the Health Care Reform Minimum Medical Loss Ratio (MLR) requirements. Rebates will be mailed to policyholders of plans in the following pools by September 30th.
Click here for the PDF of Aetna's 2020 MLR Experience Year Rebate Pools.
What happens next?
By September 30, Aetna will send notices to subscribers and policyholders/employers of plans due a rebate for Aetna, InnovationHealth and Texas Health | Aetna. The amount of the check will depend on the total premiums paid by the customer in 2020.
The pools are based upon the criteria specified by the government. In the Group market, plan sponsors are policyholders. In certain circumstances, the government requires insurers to issue rebates to subscribers of Group plans rather than policyholders. In the Individual plan market, rebate payments will be made to the subscriber policyholder of the Individual plan.
The government has issued rules on how group policyholders/employers may use the rebates. Aetna has provided an overview at www.aetna.com. Look at the bottom of the page for the Health Care Reform link or search “MLR”. Then click the link for “Affordable Care Act (ACA) & Health Care Reform – Employer | Aetna.” Aetna is not providing legal advice and suggest that plan sponsors work with their legal counsel to decide how to use the rebate.
In most cases, for group plans, policyholders (plan sponsors/employers) will receive the plan's rebate. In certain circumstances, the government has directed that the rebate goes directly to subscribers of the group policyholders. This happens if:
- The policyholder/employer has terminated, and Aetna is not able to locate them, or
- A non-ERISA/non-government policyholder failed to provide the required written assurance that they would use the rebate payment according to the government rules.
A list of MLR pools where rebates are being issued for Aetna, InnovationHealth and Texas Health | Aetna is available on www.aetna.com. Look at the bottom of the page for the Health Care Reform link.
Aetna will mail rebates to impacted plan sponsors or subscribers by 9/30.
Aetna is available to help
You can find more information on MLR on www.aetna.com. First, click “Health Care Reform” at the very bottom of the page or search for “MLR”. Then click the link for “Affordable Care Act (ACA) & Health Care Reform – Employer | Aetna.”
For questions, please contact a member of your B&P Sales Team - 888.722.3373.