March 19, 2012

EmblemHealth Requesting Group Size Information

To comply with provisions of the federal Affordable Care Act and certain other laws and regulations, we are requesting some important information from your clients concerning group size. You will find details about this request in the attached letter that we sent to groups on March 16.

Why We Are Asking for This Information

The federal health care reform law's Medical Loss Ratio (MLR) provision stipulates the percentage of premium that insurers must spend on medical care and activities that improve quality. If our costs are lower than the minimum required to be spent on these services, we issue groups a rebate. The rebate is based in part on whether a group is classified as small
or large, as defined by the federal government.

To do this, we need to know each year the average number of employees in your clients'
groups -- including employees not covered by EmblemHealth -- and provide this information to the federal government. In addition, New York State law requires that we track the number of employees that are eligible for health insurance to determine if a group is considered small or large. This is a factor in determining how we calculate a group's health insurance rates.

What Your Clients Must Do

To help us submit accurate information to the government, we are asking your clients to fill
out and mail or fax the questionnaire on the back of the letter to The Rawlings Company,
which is helping us gather this information.The Rawlings Company needs to receive
your clients' responses no later than April 15, 2012.

If you have any questions, please contact your EmblemHealth representative.