Final Medical Loss Ratio (MLR) rebate reports for UnitedHealthcare customers will be available on the broker portal the week of Sept. 15, and customers will receive their rebate payments in the mail at the end of September.
Federal law, established as part of the Affordable Care Act in 2011, requires health insurers to spend majority of their premium dollars on medical claims and activities that improve health care quality. Insurers must meet or exceed an MLR of 80 percent for the individual and small group markets, and 85 percent for the large group market. When insurers do not meet the MLR threshold, they must refund the difference to their customers via rebates.
The MLR applies to fully insured plans/policies only. The 2018 payouts are for the 2017 MLR rebate reporting year, using the 2016 average total number of employees (ATNE) to determine MLR group size. Small group size is 1 to 50 ATNE in all states except California, Colorado, New York and Vermont, where small group size is 1 to 100 ATNE. Payouts are based on the aggregation set, not on the performance of a specific employer group or individual.
The full MLR timeline is listed below:
Medical Loss Ratio (MLR) Timeline for 2017 Reporting (2018 Payout)
- April 1 – Supplemental Health Care Exhibits Report, shows preliminary MLR
- June 15 – Early Warning Report
- July 31 – Health and Human Services (HHS) MLR Rebate Reports filed and publically available on healthcare.gov in October
- Week of Sept. 8 – Final rebate reports to UnitedHealthcare sales offices
- Week of Sept. 15 – Final rebate reports to brokers on their specific customers are available on the broker portal
- Sept. 30 – All MLR Rebate checks are mailed
The MLR hotline will be available for brokers and customers in September, prior to distribution of the rebate payments.
Contact your UnitedHealthcare representative with questions.