Medical Loss Ratio rebates: When to look for your check

Results for the 2017 benefit plan year show more than $150 million in medical loss ratio (MLR) premium rebates. These purchasers fall into 49 aggregation sets (43 group and 6 individual combined). For a summary of which states, legal entities and size of business (aggregation set) will be receiving a rebate, please refer to the Final 2018 Payout Year Rebate Summary Report.

Customer reports available the second week of September

Final customer-specific results were verified in early 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. The table below shows aggregate sets and premium rebates over the past 4 years:

 

        2017

        2016

         2015

         2014

Aggregation Sets

 

 

 

 

Group Business

             43

             40

              49

              53

Individual Business

              6

              9

              14

              23

Total

             49

             49

              63

              76

 

 

 

 

 

Premium Rebates

  $150,676,168

  $114,954,917

   $105,712,174

  $117,626,280

 

Timeline and payment process

Premium rebate checks will begin mailing in mid-September and will be staggered over a 3-week period. All required payments are expected to be mailed by the Sept. 30 deadline.

Primarily, rebates will be paid to the applicable policyholder. In a limited number of cases where a group policyholder’s 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.

Support

Employers can call the service line at 1-866-802-8602 if they have questions related to the rebate payout. New this year is an Oxford-specific employer service line: 1-888-201-4216.

Background

MLR applies to fully insured group commercial plans and individual plans. The law requires insurers to spend a minimum percentage of premium dollars (80 percent for individual and small group (1-50, or 1-100 depending on the market) markets and 85 percent for large group (51+ or 101+ depending on the market) on medical services and activities designed to improve health care quality.

For the 2017 rebate reporting year (2018 payout year), California, Colorado, New York and Vermont define small group as 1-100 and large group as 101+. 

MLR is based on legal entity, state and size of employer.

  • Payouts are based on an aggregate —not on the performance of a specific employer group or individual.
  • An aggregation set is the combination of situs state, legal entity and MLR group size.
  • The calendar year for the 2017 MLR report began Jan. 1, 2017. 

Employers in certain aggregation sets (based on state, size of employer and legal entity) may get a rebate in the following states: Ariz., Calif., Colo., Del., District of Columbia, Fla., Ga., Hawaii, Ill., Iowa, La., Md., Mich., Miss, Mo., Nev., N.J., N.M., N.Y., N.C., Ohio, Okla., Tenn., Texas, Va., W. Va. and Wis.

For more information, please contact your broker or UnitedHealthcare representative.