Medical Loss Ratio (MLR) Employer Survey
Medical Loss Ratio (MLR) Process Underway at Health Net
Ensuring they remain in good standing and compliant with all government and regulatory requirements is a top priority at Health Net. Currently, Health Net is working to comply with the Medical Loss Ratio (MLR) provision of the Affordable Care Act (ACA) which requires all health care insurers to spend a certain percentage of premium revenue on medical expenses. If the MLR requirements are not met, premium rebates must be issued in the following MLR reporting year.
Health Net is communicating to employer groups and asking them to provide their 2016 average monthly number of employees. It is vital that those groups who receive a letter provide Health Net with this information so they can be accurately categorized for MLR purposes.
Employee count
The required calculation is simply the average monthly number of employees (not the number of people enrolled in, or eligible for, the health plan) in the business during the prior calendar year. Any employee who received a W-2 in 2016 – including full-time, part-time, and seasonal workers – should be counted. Note: The employee count should not include retirees or 1099 contractors.
Deadline is March 1, 2017
This is a time-sensitive process, and it’s important that your employer group clients respond to Health Net's letter as soon as possible. Health Net has made it easy for them to do so with a one-page submission form they can send to Health Net via fax or they can submit their employee count information online at www.healthnet.com/groupsizesurvey. If your clients do not submit their employee averages by March 1, 2017, their group size will be categorized based upon Health Net's current records, which may impact the MLR calculation and affect any possible premium rebate.
Two ways to submit information
Employer groups have two ways to submit their employee count information:
1. (Preferred option) submitting information online at www.healthnet.com/groupsizesurvey. The following will be needed to collect the information:
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Policyholder ID: «PHID» - Policyholder name: «GROUP»
2. Completing and faxing the submission form.
For questions, please contact a member of your B&P Sales Team - 888.722.3373.