ACA – Medical Loss Ratio (MLR) Reporting and Rebate Payments

Western Region Brokers

Starting in 2015 for 2014 reporting year, the dates insurers must report MLR results and pay rebates (if any) to policyholders have changed as follows:

  • Insurers must report their MLR results by July 31 of each year (in previous years, insurers filed results on June 1)
  • If an MLR rebate is due to the policyholder, the rebate must be paid by September 30 (previously, rebates were paid by August 1)

 

The dates changed because the 2014 and later MLR calculations now include ACA premium stabilization programs, so reporting dates occur after the premium stabilization program amounts are calculated.

 

Additional Information

The ACA requires that as a health plan and an insurance company, we are required to maintain an MLR of at least 80 percent for Individual and Small Group plans and 85 percent for Large Group plans. The MLR is the percentage of premium dollars a health plan spends on physician, hospital, and other medical services and activities that improve health care quality, including wellness programs.

This requirement is referred to as the “Medical Loss Ratio” standard or the “80/20” or “85/15” rule. If Health Net does not meet the standards in this rule, we must refund part of the premium. The ACA rule was designed to ensure groups and members receive optimal value for their health care dollars.

If you have any questions regarding this announcement, please contact your Health Net Small Business Group Account Executive or Account Manager.

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Susan Peters