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Anthem Sending MLR Surveys to Employers

Jul 27, 2012

According the Affordable Care Act (or health care reform law), health insurers must categorize employer groups as either Small or Large based on the average number of full-time equivalent employees they have. This requirement is in conjunction with the medical loss ratio rules. As a reminder, the medical loss ratio provision applies to the portion of premium spent on medical care and quality improvement programs for the members covered under fully insured group health plan.  

Because Anthem only has data on how many are enrolled in health plans, they need to survey employers for the average number of full-time equivalent employees they had in 2011 to effectively categorize them as Small or Large group. This information is important for Anthem to have because they are required to meet different medical loss ratio thresholds for Individual /Small group and Large group markets. Therefore, the way a group is categorized could have an impact on the rebate amount it receives if rebates are required. The information collected will only be used to categorize groups for the 2011 calendar year medical loss ratio reporting.

Beginning July 25, 2012, Anthem will send the survey to all of their fully insured local group customers.

For more information, see these frequently asked questions and answers.

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