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Medical Loss Ratio Surveys Going to Fully Insured Clients

Jun 06, 2017

​As part of the Medical Loss Ratio (MLR) provision of the Affordable Care Act (ACA or health care reform law), health insurers must categorize employer groups as either small or large, based on the average number of employees they have. This includes full-time, part-time and seasonal employees. As a reminder, the MLR provision applies to the amount of premium spent on medical care and quality improvement programs for members covered under fully insured group health care plans. 

In May, Anthem will mail surveys to all of their fully insured, local group customers to determine the average number of employees they had in 2016. If Anthem doesn’t hear back, they may send periodic reminders. With this information, Anthem can categorize them effectively as a small or large group. Anthem needs this data to meet different MLR thresholds for Individual, Small Group and Large Group markets. 

The way a group is categorized could impact the rebate amount it gets, if it is eligible for one. The data will be used only to categorize groups for the 2017 calendar year MLR reporting. If a group doesn’t respond, it will be categorized based on the current membership numbers Anthem has.

For questions, please ​contact a member of your B&P Sales Team - 888.722.3373.

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