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Medical Loss Ratio Determinations

On 12/2/2011, the Department of Health and Human Services (HHS) released the final rule regulating the Medical Loss Ratio (MLR) requirements of the Patient Protection and Affordable Care Act (PPACA). The final rule makes important changes to the way the law was originally outlined.

One change relates to who the rebate recipients should be in the large and small group markets. Specifically, for ERISA plans, rebates are to be paid directly to the policyholder/plan sponsor (most often the employer) instead of to each premium payer, which in most situations could have included employees.

A key component of our MLR Questionnaire revolves around collecting premium contribution information. Since, for most policyholders/plan sponsors, we no longer need to rebate to employees (or former employees), groups no longer need to provide us with premium contribution information. Accordingly, we are suspending our MLR-related data collection efforts.

As such, the web portal is closed while we assess the longer term impact the final rule will have on you as well as how it will impact our own plans to administer the rebate process, if applicable. If you have already completed the questionnaire, we appreciate your cooperation.

Our commitment to you is to share what we know when we know it; consistent with our tagline, “when you care more, you do more.”

As previously communicated, our support team will be available through December 31, 2011 to answer questions. You may also contact your Account Executive if you have any questions about the MLR regulations or Health Care Reform in general.