News & Updates
Anthem groups and Individual members in 9 states will receive 2021 medical loss ratio (MLR) rebates this year. Anthem mailed the rebates during the week of 9/5/22.
The MLR provision of the Affordable Care Act (ACA) encourages health plans to spend most of the premium dollars they collect on healthcare costs rather than overhead. MLR is a ratio of insurance premiums to claims costs, usually expressed as a percentage.
In the Fully Insured Small Group and Individual markets, the MLR provision requires plans to spend at least 80% of premium income on healthcare claims and quality improvement. In the Fully Insured Large Group market, it requires plans to spend at least 85%. In markets where Anthem doesn’t meet the minimum ratio, they’re required to issue rebates to employer groups and Individual members. ASO plans and stop-loss insurance are excluded from the rebates.
Along with the rebate checks, Anthem will send employer groups and Individual members a federally mandated notice that explains MLR and how it is calculated.
Ways in Which an Employer Can Distribute the Rebate
If the group health plan is a non-Federal governmental plan, the employer or group policyholder must distribute the rebate in one of two ways:
View Anthem's MLR FAQs for more details on the rebates.
Please reach out to your Anthem representative if you have questions.
For questions, please contact a member of your B&P Sales Team - 888.722.3373.