Medical Loss Ratio (MLR) Process Underway at Health Net

Ensuring we remain in good standing and compliant with all government and regulatory requirements is a top priority at Health Net. Currently, we are working to comply with the Medical Loss Ratio (MLR) provision of the Affordable Care Act (ACA) which requires all health care insurers to spend a certain percentage of premium revenue on medical expenses. If the MLR requirements are not met, premium rebates must be issued in the following MLR reporting year.We want to let you know that we are communicating to employer groups and asking them to provide us with their 2016 average monthly number of employees. It is vital that those groups who receive a letter provide us with this information so they can be accurately categorized for MLR purposes.

Employee count

The required calculation is simply the average monthly number of employees (not the number of people enrolled in, or eligible for, the health plan) in the business during the prior calendar year. Any employee who received a W-2 in
2016
– including full-time, part-time and seasonal workers – should be counted. Note: The employee count should not include retirees or 1099 contractors.

Deadline is March 1, 2017

This is a time-sensitive process, and it’s important that your employer group clients respond to our letter as soon as possible. We have made it easy for them to do so with a one-page submission form they can send to us via fax or, for better convenience, they can submit their employee count information online at this link: http://www.healthnet.com/groupsizesurvey. If your clients do not submit their employee averages by March 1, 2017, their group size will be categorized based upon our current records, which may impact the MLR calculation and affect any possible premium rebate.

Two ways to submit information

Employer groups have two ways to submit their employee count information. The preferred option is by submitting information online at www.healthnet.com/groupsizesurvey. The following will be needed to collect the information:

  • Policyholder ID: «PHID»
  • Policyholder name: «GROUP»

A second option is completing and faxing this form:

MLR_Survey_Employer_Ltr_and_Form

If you have any questions or would like further details, please contact your dedicated Health Net sales representative.

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