Announcement from Anthem
April 26, 2016
As part of the Medical Loss Ratio (MLR) provision of the Affordable Care Act (ACA or health care reform law), health insurers must categorize employer groups as either small or large, based on the average number of employees they have. This includes full-time, part-time and seasonal employees. As a reminder, the MLR provision applies to the amount of premium spent on medical care and quality improvement programs for members covered under fully insured group health care plans.
In May, we will mail surveys to all of our fully insured, local group customers to determine the average number of employees they had in 2015. If we don’t hear back from them, we may send periodic reminders. With this information, we can categorize them effectively as a small or large group. We need this data to meet different MLR thresholds for Individual, Small Group and Large Group markets.
The way a group is categorized could impact the rebate amount it gets, if it is eligible for one. The data will be used only to categorize groups for the 2016 calendar year MLR reporting. If a group doesn’t respond, it will be categorized based on the current membership numbers we have.
Email tanya@agent-link.net for more information.
This article applies to:
- Wisconsin, Ohio, Missouri, Kentucky, and Indiana
- Small Group and Large Group
