New Fact Sheets on Medical Loss Ratios
On November 22, the U.S. Department of Health and Human Services issued interim final regulations for the medical loss ratio provision of the health care reform law. The interim final rules clarify how the medical loss ratio will be calculated and reported, and provide details on the rebate process. In addition, the interim final rules confirm that the medical loss ratio provision does not apply to self-insured or ASO plans. It applies only to the issuer of insurance plans in the large and small group and individual markets.
For more details and talking points, refer to this fact sheet.
Employer enforcement of exclusion for dependents who are eligible for their own employer-sponsored coverage
The health care reform law allows grandfathered group health plans to exclude coverage for young adult dependents who are eligible for their own employer-sponsored coverage. While we aren't making this exclusion standard, 100+ grandfathered groups can choose to have the exclusion.
If a group chooses to exclude coverage for dependents who are eligible for their own employer-sponsored coverage, we will add the exclusion to the group's certificate language. However, we will not enforce the exclusion on behalf of the group. The employer will need to develop a method that suits its particular needs, as well as materials that support the enforcement method (such as an affidavit for employees to verify that their covered dependents are not eligible for their own coverage).