July 2, 2012
Notifying Policyholders About MLR Requirements and Rebates
The federal Affordable Care Act's Medical Loss Ratio (MLR) provision requires health insurers to spend most of the premiums they receive on medical care and activities that improve the quality of care. If the insurer's costs are lower than the minimum required to be spent on these services, the insurer will issue policyholders a rebate. This rebate will be based in part on whether the recipient is classified as a small or large group (as defined by the federal government) or as an individual (including sole proprietors). In addition, the MLR rebate issued depends upon the policyholder's specific plan.
We will be mailing letters to all EmblemHealth individual and group policyholders on or before August 1, 2012 letting them know whether or not they will be receiving a rebate from their plan. Below are answers to questions you or your clients may have about the MLR requirements and eligibility for a rebate:
Q: Who is affected by the MLR requirements?
Q: Is a group that no longer has coverage still eligible for the rebate?
Q: What factors determine whether a policyholder is eligible for a rebate?
Q: Is a group required to have a specific number of employees to be eligible
Q: Are self-funded plans subject to MLR reporting and rebate requirements?
At EmblemHealth, our goal has always been to offer a range of coverage choices for groups and individuals — including flexible pharmacy and benefits designs, and cost-sharing options for all budget levels. We are pleased that the number of rebates is minimal and our competitive pricing appropriately reflects medical costs in the region.
If you have any questions, please contact your EmblemHealth representative.
|Group Health Incorporated (GHI), GHI HMO Select, Inc. (GHI HMO), HIP Health Plan of New York (HIP), HIP Insurance Company of New York and EmblemHealth Services Company, LLC are EmblemHealth companies. EmblemHealth Services Company, LLC provides administrative services to the EmblemHealth companies.|