2020 MLR payouts, key dates and updates

2020 Medical Loss Ratio (MLR) payouts are for the 2019 MLR rebate reporting year using the 2018 average total number of employees (ATNE). To qualify, insurers must meet or exceed an MLR of 80% for individual and small-group markets, and 85% for large-group market.

• MLR applies to fully insured plans only.
• Rather than performance of a specific employer group or individual, MLR is based on legal entity, state and size of employer, and payouts are based on an aggregate of those factors.
• For 2020 reporting, most states use 1 to 50 average total number of employees (ATNE) to determine small group. Only 4 states use 1 to 100 ATNE for 2019 reporting – California, Colorado, New York and Vermont.

Key dates for 2020 MLR payout:

April 1 – Supplemental Health Care Exhibits Report

June 19 – Early Warning Report

Aug. 17 – Health and Human Services (HHS) MLR Rebate Reports (extended due to COVID-19)

Sept. 11–14 – MLR Final Rebate Reports

Sept. 14–30 – All Checks Mailed

Rebate impact
The 2019 payout is forecasted for 48 aggregation sets (22 small group, 26 large group) in 28 states, plus Washington, D.C. There are 3 states plus Washington, D.C. and 4 aggregation sets for individual policies. The 2020 payout is forecasted for 58 aggregation sets (27 small group, 31 large group) in 33 states plus Washington, D.C. There are 3 aggregation sets (in 3 states) for individual policies.

There may be additions or deletions to these projected states/aggregation sets when the final report is released.

The MLR hotline will be available beginning on Sept. 1, 2020.

• MLR Employer/Broker Hotline: 1-866-802-8602
• Oxford MLR Employer/Broker Hotline: 1-888-201-4216

To find out if your groups may be eligible for a rebate, contact your UnitedHealthcare representative.