The Affordable Care Act (or health care reform law) requires health plans to meet a minimum medical loss ratio, which varies according to market. Health insurance issuers must meet a minimum medical loss ratio of 85% in the fully insured large group market and 80% in the fully insured small group and individual markets. (States that received waivers to have a lower threshold for the individual market are required to meet that percentage and not the 80% in the health care reform law.)Medical loss ratio requirements do not apply in the ASO market.
The health care reform law also requires health plans to file a medical loss ratio report on fully insured business each year with the Department of Health and Human Services (HHS). On June 1, 2012, we filed the required medical loss ratio report with HHS for the 2011 calendar year.
For 2011, we met the required loss ratio for all markets where our National Accounts clients have fully insured plans. Members in fully insured plans will receive postcards with this information, notifying them that we met the minimum medical loss ratio and no rebate will be issued as required by law.
All notices will be sent before August 1, 2012.