UnitedHealthcare will begin mailing MLR premium rebate checks to impacted groups in September

Premium rebate checks begin to go out mid-September and will be staggered over a three-week period.  Fully insured customers who are qualified to receive premium rebates for the 2023 MLR Payout Year will receive their checks by the Sept. 30 deadline.

MLR payouts vary by legal entity and size of group for states receiving a rebate.  Payout is not based on individual performance of the group and not all states receive rebates. Brokers may access specific customer information in United eServices® by mid-September prior to checks being mailed to the customer.

For benefit plan year 2022 (2023 MLR Payout Year), UnitedHealthcare’s results show 46 group aggregation sets in 25 states — 21 small group and 25 large group — are qualified to receive premium rebates totaling $120,924,328.  Also, 8 individual aggregation sets are qualified to receive rebates totaling $17,303,569.

For a summary of which states, legal entities and size of business (aggregation set) that will receive a rebate, refer to the Final 2023 MLR Rebate Payout Report.

Final customer-specific results were verified in August 2022. Prior to mailing checks, UnitedHealthcare sales and account managers, as well as brokers, will have access to rebate reports to assist customers with any questions regarding their eligibility for a rebate in September.

The reports include the amount of rebate owed and paid, as well as the MLR percentage achieved by the aggregation set in which the policyholder was grouped.

Below is a table showing the aggregation sets and premium rebates over the past three years.

Primarily, rebates will be paid to the applicable policyholder. In a limited number of cases where a group policyholder written assurance was required but not received, the subscribers of those groups will receive the premium rebate checks. In addition to the checks mailing to policyholders, notices of the rebate also will be mailed to the subscribers of those group policyholders receiving a rebate.

Brokers and customers can call the Broker/Employer service line at 866-802-8602 if they have questions related to the rebate payout. The Oxford specific Broker/Employer service line is 1-888-201-4216. Both services lines opened for calls on Sept. 1.

• MLR applies to fully insured group commercial plans and individual plans.
• The law requires insurers to spend a minimum percentage of premium dollars — 80% for individual and small group (1–50, or 1–100 depending on the market) markets and 85% for large group (51+ or 101+ depending on the market) — on medical services and activities designed to improve health care quality.
• For the current rebate reporting year, the following 4 states define small group as 1–100 and large group as 101+: California, Colorado, New York, and Vermont. 
• MLR is based on legal entity, situs state and MLR group size of employer, called an aggregation set.
• MLR payouts are based on performance of the aggregation set — not on the performance of a specific employer group or individual.
• For more information, refer to the list of states by employer size and legal entity or your specific customer reports on United eServices.
• Different rules apply for different plan types (e.g., ERISA, Fed Government, Non-Fed Government, Non-ERISA & Non-Government, and terminated groups) are set forth in the rebate notice. Employers may contact the Department of Labor’s Employee Benefits Security Administration at 1-866-444-EBSA (3272) or review the Department’s technical guidance on this issue on the DOL website.
• Information on any tax implications on receipt of rebate payments either by the group policyholder or subscriber is on the IRS website.

For questions contact the broker or your UnitedHealthcare representative.