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:
- Reducing premium for the upcoming year; or
- Providing a cash rebate to employees or subscribers that were covered by the health insurance on which the rebate is based.
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.