The MLR provision of the Affordable Care Act requires all health insurance companies to spend a certain percentage of premium dollars on medical expenses that improve the quality of health care. If the MLR threshold is not met, the insurer is require to provide a premium rebate back to the policy holder in that market segment.
What is the Required MLR Threshold?
- Large Group Market – 85%
- Individual and Small Group Market – 80%
- MA Merged Market (small groups under 51 benefit eligible employees and most non-group plans) – 89%
Insurers were required to report their MA Merged Market MLR calculations with the Massachusetts Division of Insurance and their Federal MLR calculations with Health and Human Services (HHS) on July 30, 2017.
Will Harvard Pilgrim be issuing any 2016 rebates and to whom?
Harvard Pilgrim met all Federal and MA Merged Market minimum MLR requirements and will not be issuing any rebates under the Federal Affordable Care Act or state law.
What are employer responsibilities around the MLR rebate?
Employers/administrators of the group health plan may have fiduciary responsibilities regarding use of this MLR rebate. For general information on the usage of this rebate, you may contact the Department of Labor (DOL) at 1-866-444-EBSA (3272) or review the Guidance on Rebates on the DOL's web site. Please consult with your legal advisor regarding the use of the rebate.