Jul 22, 2022
The Affordable Care Act (ACA) requires health carriers to maintain an MLR of at least 80 percent for Individual and Small Group Plans and 85 percent for Large Group Plans. The MLR is the percentage of premium dollars a health plan spends on physician, hospital, and other medical services and activities that improve health care quality, including wellness programs.
As a result of a review of the 2017, 2018, 2019, and 2020 MLR Annual Reporting Forms, it was determined that Health Net had to recalculate its MLR for those years and they are providing affected groups with a premium rebate that is due as a result.
- For California Individual and Large Group HMO and PPO Plans in 2017, 2018, 2019, and 2020 Health Net met or exceeded the MLR standards
- For California Small Group Plans in 2017, 2018, 2019, and 2020, Health Net Life Insurance Company (PPO) met or exceeded the 80 percent MLR standard.
- For California Small Group Plans in 2017, Health Net Insurance Company of California, Inc. (HMO) met or exceeded the 80 percent MLR standard.
- For California Small Group Plans in 2018, 2019, and 2020, Health Net of California, Inc. (HMO) did not meet the 80 percent MLR standard.
This means that Small Group Clients who had Health Net HMO plans in 2018, 2019, and/or 2020 will receive a rebate of a portion of the premium as required under the ACA. Pending Health Net releases, more information on the Off Cycle MLR Results will soon be available.
Contact your Amwins Connect Regional Sales Manager for more information.
