News & Updates
The Affordable Care Act (ACA) requires health carriers to maintain an MLR of at least 80 percent for Individual and Small Group Plans and 85 percent for Large Group Plans. The MLR is 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 MLR standard or the “80/20” or “85/15” rule. If those standards are not met, the Health Plan or Insurance Carrier must refund part of the premium. The MLR standard was created to provide more transparency and accountability around health care costs.
This means that your Small Group Clients who had Health Net of California, Inc. HMO plans in 2020 will receive a rebate of a portion of the premium as required under the ACA.
What This Means to Your Clients and You
Health Net is required to provide this rebate by September 30, 2021. Small Employer Groups who are eligible for a rebate will receive check. The rebate amount and the method of rebate may vary by state, family size and/or amount of premium paid.
There aren’t any changes to the current premium, deductible, or copay amounts as a result of the rebate. Broker commissions are also not affected by this transaction.
Questions? Please contact your Health Net Sales Representative with any questions you may have.