Health Net Has Finalized its 2023 Medical Loss Ratio (MLR) Results

Learn how employer groups and subscribers are affected.

The Affordable Care Act (ACA) requires health carriers to maintain a Medical Loss Ratio (MLR) of at least 80% for Individual and Small Group plans and 85% for Large Group plans. 

This requirement is referred to as the MLR standard or the "80/20" or "85/15" rule. If a health plan doesn’t meet the standard it must refund part of the premium. 

Here are the Health Net 2023 MLR results for California IFP, Large Group and Small Group plans: 

• • IFP: Health Net met or exceeded MLR standards for HMO and PPO plans. 
• • Large Group: Health Net met or exceeded MLR standards for HMO and PPO plans. 
• • SBG: Health Net met or exceeded MLR standards for PPO plans (Health Net Life Insurance Company) and HMO plans (Health Net of California, Inc.). 

Because Health Net met or exceeded the MLR targets for California IFP/IEX, SBG and LRG market segments, subscribers and employer groups will not receive 2023 plan year rebates. 

These 2023 MLR results were filed with the Centers for Medicare & Medicaid Services (CMS) prior to the August 15, 2024, due date. 

Amwins is committed to keeping you informed and providing resources you can use.  Click here for more on this topic.