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No MLR Rebates from Anthem

Aug 18, 2016

The Affordable Care Act (ACA or health care reform law) requires health plans to meet a minimum medical loss ratio (MLR), which varies according to market. Health insurance issuers must meet a minimum MLR of 85% in the fully insured large group market and 80% in the fully insured small group and individual markets. (States that received waivers to have a lower threshold for the individual market are required to meet that percentage, not the 80% in the ACA.)* The health care reform law also requires health plans to file an MLR report each year with the Department of Health and Human Services (HHS).

On July 31, Anthem filed the required MLR report with HHS for the 2015 calendar year.

They met the required loss ratio for all lines of business in 2015 for their Anthem Blue Cross Life and Health Insurance Company products under the California Department of Insurance (CDI) and their Anthem Blue Cross of California products under the Department of Managed Health Care (DMHC). As a reminder, medical loss ratio requirements do not apply in the ASO (Administrative Services Only) market, and short-term medical insurance is excluded from rebates.

View this fact sheet for more details and FAQs.

For questions, please contact a member of your b&p Sales Team - 888.722.3373.

* Note: There are no waivers in effect for the 2015 year. However, the MLR calculation uses a three-year average. Therefore, the waiver impacts the 2015 rebates being paid in 2016.

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