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Anthem to Issue Rebates for Small Group and Individual Markets
Jul 09, 2012
The Affordable Care Act (health care reform law) requires health plans to meet a minimum medical loss ratio (MLR), which varies according to market. Health insurance issuers must meet a minimum medical loss ratio of 85% in the fully insured Large Group market and 80% in the fully insured Small Group and Individual markets.
The health care reform law also requires health plans to file a medical loss ratio report each year with the Department of Health and Human Services. On June 1, 2012, Anthem Blue Cross filed the required medical loss ratio report for the 2011 calendar year.
Anthem Blue Cross MET the required loss ratio in the:
Anthem Blue Cross DID NOT MEET the required loss ratio in the:
- Small Group market for the California Department of Insurance (CDI)
- Large Group market for the California Department of Insurance (CDI)
- Large Group market for the Department of Managed Health Care (DMHC)
- Individual market for the Department of Managed Health Care (DMHC)
What does this mean?
- Small Group market for the Department of Managed Health Care (DMHC)
- Individual market for the California Department of Insurance (CDI)
- Members in the Large Group market will get postcards with the information notifying them that Anthem met the minimum medical loss ratio and no rebate will be issued as required by law.
- Members in the Individual market for Anthem Blue Cross Life and Health Insurance Company products we will receive a required notification along with the rebate check to the member.
- Members in the Small Group market for our Anthem Blue Cross products will receive the required notification and rebate check to the employer as required by law. Enrollees in the employer health plans will also receive the notification.
Rebate Check and Notification Schedule for California Small Groups and Individuals
To make sure Anthem Small Group customers and Individual members understand (1) why they’re receiving rebate checks, (2) who receives them and (3) when the checks will be sent, Anthem is sending pre-rebate notifications to impacted group employers and Cal-Cobra members.
Employers receiving rebates can use the rebates to:
Affect on Broker Commissions
- Medical loss ratio rebates will not affect broker commissions for the 2011 calendar year.
For additional questions and assistance, please contact your beere&purves Group Sales Representative - 888.722.3373.