Health Net Finalizes 2012 MLR Results

Jun 05, 2013

Health Net works hard to provide timely and relevant information that affects your clients and your business. They want to inform you that Health Net of California, Inc. and Health Net Life Insurance Company have finalized the 2012 Medical Loss Ratio (MLR) results.

The MLR standard
The federal Affordable Care Act (ACA) requires that as a health plan and an insurance company, Health Net is required to maintain an MLR of at least 80 percent for Individual and Small Group plans and 85 percent for Large Group plans. That’s the percentage of premium dollars a health plan spends on physician, hospital, and other medical services and activities that improve health care quality, including wellness programs.

This requirement is referred to as the “Medical Loss Ratio” standard or the “80/20” or “85/15” rule. If Health Net does not meet the standards in this rule, they must refund part of the premium. The ACA rule was designed to ensure your clients receive optimal value for their health care dollars.

More information about the rule and other provisions of the health reform law can be found at http://www.healthcare.gov/law/features/costs/value-for-premium/index.html.

2012 MLR results

For Individual business, Health Net of California, Inc. and Health Net Life Insurance Company met or exceeded the 80 percent MLR standard.

For Large Group business, Health Net of California, Inc. and Health Net Life Insurance Company met or exceeded the 85 percent MLR standard.

For Small Group business, Health Net Life Insurance Company met or exceeded the 80 percent MLR standard.

For Small Group business, Health Net of California, Inc. did not meet the 80 percent MLR and will be rebating a portion of the premium.
- Groups will begin to receive letters notifying them of their rebate between June 1 and August 1, 2013.
- Active groups will receive premium credits on their August billing statement.
- Groups that have terminated will receive a check in the mail.
- Subscribers will be mailed notification before the end of July.
- Rebates will not be paid to group policyholders and/or subscribers if the rebates owed are less than the de minimus amount, as set in the MLR Rule.

To summarize, Health Net of California Small Group Business HMOs, EOAs & POS plans should be receiving an MLR rebate.

Example Notifications

More information and official MLR results can be found at http://companyprofiles.healthcare.gov/MlrQA.

For assistance with Health Net questions, please contact your b&p Sales Team - 888.722.3373.