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No MLR Rebates Issued for California

Aug 24, 2015

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 2014 calendar year.

Anthem met the required loss ratio for all lines of business in 2014 for Anthem Blue Cross Life and Health Insurance Company products under the California Department of Insurance (CDI) and Blue Cross of California products under the Department of Managed Health Care (DMHC). As a reminder, MLR requirements do not apply in the ASO market and short-term Medical insurance is excluded from rebates.

View this fact s​heet for more details and FAQs. For all other health care reform needs, please visit www.makinghealthcarereformwork.com.

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

*Note: There are no waivers in effect for the 2014 year. However, the MLR calculation uses a 3 year average. Therefore, the waiver impacts the 2014 rebates being paid in 2015.

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