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 (including Innovation Health, Banner | Aetna, subsidiaries, and affiliates) is paying rebates in some markets. The rebates Aetna is paying are modest, and most policyholders/employers won't receive a rebate at all.
Click here for the PDF of Aetna's 2019 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, Innovation Health and Banner | Aetna. The amount of the check will depend on the total premiums paid by the customer in 2019.
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, Innovation Health and Banner | 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.
List of employees/Roster request process
You can request a list of employees/roster on behalf of your impacted plan sponsor by calling the MLR service center at 1-855-697-7509 between 10:00 am and 6:30 pm EST, Monday through Friday.
If you already indicated your plan sponsor would like an employee roster you do not need to request another one. Only request an employee roster if your plan sponsor requests one.
If an email roster was requested, it will be sent securely from the [email protected] mailbox and will include instructions on how to open the message for viewing. The roster will be sent at the same time as the rebate check.
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.