News & Updates
As part of the medical loss ratio (MLR) provision of the Affordable Care Act (ACA 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. As a reminder, the 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.
In May, Anthem sent surveys to all of their fully insured, local group customers to determine the average number of employees they had in 2014. With this information, Anthem could categorize them effectively as a Small or Large Group. This included full-time, part-time and seasonal employees. Anthem needs this data to meet different MLR thresholds for Individual, Small Group and Large Group markets.
To make sure Anthem reaches out to all groups, at the end of October they mailed the survey a second time to roughly 4,000 groups across their markets. These were groups that joined Anthem's membership after the May survey deployed.
Anthem has discovered that some of the second surveys requested a July 31st response date in error. If a client asks you the due date, the correct date is November 30. Anthem will send a reminder email to the groups that got the second survey. At that time, they’ll also remind them that the actual due date for their survey response is November 30, 2015.
The way a group is categorized could impact the rebate amount they get, if they are eligible for one. The data will be used only to categorize groups for the 2015 calendar year MLR reporting. If a group doesn’t respond, it will be categorized based on the current membership numbers we have.
For questions, please contact a member of your b&p Sales Team - 888.722.3373.