MLR FAQs for Subscribers

How do I know if I’m getting a rebate?
Subscribers receiving rebates are being directly notified by mail. If you have enrolled in “Go Paperless” (opted to receive your plan communications electronically), you’ll receive your notice by email with a direct link to your account and the full notification details once you log in.

How will I receive my rebate?
If you had individual coverage in a market segment where Harvard Pilgrim did not meet the MLR requirement, then Harvard Pilgrim will issue a rebate check or premium credit.

If you had employer group coverage in a market segment where Harvard Pilgrim did not meet the MLR requirement, then Harvard Pilgrim will issue your employer a rebate check or premium credit.

Why am I getting this MLR rebate?
Your rebate represents the difference between what Harvard Pilgrim anticipated (the rates set in advance of 2019, which were based on the most current data at that time), and what was actually spent in terms of your health care premium. You’re getting money back this year because the medical costs for 2019 were lower than projected.

What if I have Auto Pay?
Premium credits will be reflected in the Amount Due field shown on your statement and the reduced amount paid automatically.

How did you determine my rebate amount?
MLR rebates are calculated using the following formula:

Clinical Services + Quality Improvement Expenses
________________________________________

Earned Premium – Taxes and Fees

The rebate calculated as shown above is based on a combination of factors, including legal entity, state and group size, within a particular business segment. It is not based on any one customer’s services and expenses.

What is considered an activity that improves healthcare quality?
Quality improvement activities are designed to improve the quality of care received by the health plan member. The intended improvements must be tracked and also measurable and verifiable by objective standards. Examples of  quality improvement activities and programs:    

  • Reducing medical errors
  • Preventing hospital re-admissions
  • Reducing health disparities
  • Promoting wellness and healthy lifestyle habits

Learn more about Harvard Pilgrim’s Quality programs

Are individuals who are not receiving a rebate getting notified?
No, only individuals who will be receiving an MLR rebate for 2019 will be notified.

Will subscribers be notified if their employers are receiving a rebate?
Yes. The notice we send to enrolled subscribers whose employers are receiving a Massachusetts state and/or federal rebate will be postmarked no later than September 30.

How does my employer distribute MLR rebates to employees?
If your group health plan is subject to the Federal Employee Retirement Income Security Act of 1974 (ERISA), your employer may have fiduciary responsibilities regarding use of the MLR rebates. Some of or the entire rebate may be an asset of the plan, which must be used for the benefit of the employees covered by the policy. For general information about your employer’s responsibilities regarding the rebate, ask your benefits administrator or your HR department.

It will be your employer’s responsibility to distribute the rebate to their employees according to DOL rebate regulations.

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