The Affordable Care Act (ACA) requires health carriers to maintain an Medical Loss Ratio (MLR) of at least 80 percent for Individual and Small Group Plans and 85 percent for Large Group Plans.
This requirement is referred to as the MLR standard or the "80/20" or "85/15" rule. If Health Plans do not meet those standards, the Health Plan must refund part of the premium.
2022 MLR Results for California IFP, LRG and SBG Plans
- IFP: Health Net met or exceeded MLR standards for HMO and PPO plans.
- Large Group: Health Net met or exceeded MLR standards for HMO and PPO Plans.
- SBG: Health Net met or exceeded MLR standards for PPO plans (Health Net Life Insurance Company) and HMO plans (Health Net of California, Inc.). 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.
California and Oregon IFP/IEX, SBG, and LRG subscribers and employer groups will not receive 2022 plan year rebates since Health Net met or exceeded the MLR targets for those market segments.
The 2022 MLR results were filed with the Centers for Medicare & Medicaid Services (CMS) prior to the July 31, 2023, due date.
For questions, please contact a member of your B&P Sales Team - 888.722.3373.