As part of the Medical Loss Ratio (MLR) provision of the Affordable Care Act (ACA), health insurers must categorize clients as either individual, small group or large group. For employer groups, this is determined based on the average number of employees they had in 2017. This includes full-time, part-time and seasonal employees. This 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.
Anthem is required to send your clients the MLR request for group size
When your clients complete the brief one-question request and return it, Anthem can accurately categorize their business. They’ll begin collecting this information from their fully insured clients this summer and may follow up with an email, if they haven’t heard back from them.
Although most fully insured small and large group customers will get the notice, a small subset of customers will not get it, because it does not apply to them. If any of your clients ask why they haven’t received the MLR request, it is most likely because the request doesn’t apply to them.
If Anthem doesn’t hear from your clients, their company will be categorized based on the current membership numbers Anthem has for them. Rebate status will be based on reported group size. No action is required of customers who are not fully insured. This can impact the manner in which your client is categorized and this could impact the rebate amount they get if they are eligible.
For questions, please contact a member of your B&P Sales Team - 888.722.3373.