Medical Loss Ratio (MLR) Results: 2023 Plan Year

Sep 24, 2024

Medical Loss Ratio Requirements for the 2023 plan year:

IFP & Small Group: Carriers must spend no less than 80% of premium revenue on medical expenses.
Large Group: Carriers must spend no less than 85% of premium revenue on medical expenses.

For any carrier that did not meet MLR in a market segment, policyholders with members enrolled in affected plans will receive a refund by September 30, 2024.

CARRIER	MLR RESULT			DESCRIPTION OF REBATE	REBATES
	IFP	SMALL GROUP	LARGE GROUP		MAILED BY	SENT TO
Banner\|Aetna	MLR Met	MLR Met	MLR Not Met	2023 MLR Experience Year Rebate Pools, Banner\|Aetna Health Plan Inc will pay rebates to members.	Sept 30	Employer
Blue Cross Blue Shield of Arizona	MLR Met	MLR Not Met	MLR Met	Rebates due in small group market.	Sept 30	Employer
Cigna + Oscar	Carrier will not release results			-	-	-
Humana	-	MLR Not Met	MLR Met	Rebates due in small group market.	Sept 30	Employer

CARRIER	MLR RESULT			DESCRIPTION OF REBATE	REBATES
	IFP	SMALL GROUP	LARGE GROUP		MAILED BY	SENT TO
Aetna	MLR Met	MLR Met	MLR Met	No rebates will be issued.	-	-
Anthem Blue Cross	MLR Met	MLR Met	MLR Not Met	Rebates due for Anthem Blue Cross Life and Health Insurance Company, PPO products.	Sept 30	Employer
Blue Shield of California	MLR Met	MLR Met	MLR Met	No rebates will be issued.	-	-
Cigna + Oscar	Carrier will not release results			-	-	-
Health Net	MLR Met	MLR Met	MLR Met	No rebates will be issued.	-	-
Kaiser Permanente	MLR Met	MLR Met	MLR Met	No rebates will be issued.	-	-
Sharp Health Plan	MLR Met	MLR Met	MLR Met	No rebates will be issued.	-	-
Sutter Health Plus	MLR Met	MLR Met	MLR Met	No rebates will be issued.	-	-
UnitedHealthcare	-	MLR Not Met	MLR Not Met	Rebates due for small group with UnitedHealthcare Benefits Plan of California and ACN Group of California Inc, and for large group with U.S. Behavioral Health Plan, California. View the 2024 Medical Loss Ratio Final Payout Report	Begins mid-Sept, with all sent by Sept 30	Employer
Western Health Advantage	MLR Met	MLR Met	MLR Met	No rebates will be issued.	-	-

* The following carriers are not subject to MLR: CaliforniaChoice, Covered California, and MediExcel Health Plan. For Covered California and CaliforniaChoice, refer to the enrolled carrier for results.

CARRIER	MLR RESULT			DESCRIPTION OF REBATE	REBATES
	IFP	SMALL GROUP	LARGE GROUP		MAILED BY	SENT TO
Aetna Florida	MLR Met	MLR Not Met	MLR Not Met	2023 MLR Experience Year Rebate Pools, Aetna Health Inc will pay rebates to members.	Sept 30	Employer
Anthem Georgia	MLR Met	MLR Not Met	MLR Met	Rebates due for Blue Cross Blue Shield Healthcare Plan of Georgia.	Sept 30	Employer
Florida Blue Florida	MLR Met	MLR Met	MLR Met	No rebates will be issued.	-	-
Humana Florida	-	MLR Met	MLR Met	No rebates will be issued.	-	-

CARRIER	MLR RESULT			DESCRIPTION OF REBATE	REBATES
	IFP	SMALL GROUP	LARGE GROUP		MAILED BY	SENT TO
Aetna D.C	MLR Met	MLR Met	MLR Met	No rebates will be issued.	-	-
Aetna Maryland	MLR Met	MLR Met	MLR Not Met	2023 MLR Experience Year Rebate Pools, Aetna Heath Inc will pay rebates to members	Sept 30	Employer
Aetna Virginia	MLR Met	MLR Met	MLR Not Met	2023 MLR Experience Year Rebate Pools, Innovation Health Plan will pay rebates to members	Sept 30	Employer
Anthem Virginia	MLR Not Met	MLR Not Met	MLR Met	Rebates due for individual through HealthKeepers (HMO), and small group through Anthem Health Plans of Virginia (PPO).	Sept 30	Employer, or individual for IFP
CareFirst District of Columbia	MLR Met	MLR Met	MLR Met	No rebates will be issued. View announcement and FAQs	-	-
CareFirst Maryland	MLR Not Met	MLR Not Met	MLR Met	Rebates due for Small Group CFMI, Individual GHMSI, and Individual CFMI Catastrphic MiniMed plans. View announcement and FAQs	Begins Sept 9, with all sent by Sept 30	Employer
CareFirst Virginia	MLR Met	MLR Met	MLR Not Met	Rebates due for Large Group BlueChoice plans. View announcement and FAQs	Begins Sept 9, with all sent by Sept 30	Employer
Sentara Virginia	MLR Met	MLR Met	MLR Met	No rebates will be issued.	-	-
UnitedHealthcare District of Columbia	-	MLR Met	MLR Met	No rebates will be issued. View the 2024 Medical Loss Ratio Final Payout Report	-	-
UnitedHealthcare Maryland	MLR Not Met	MLR Not Met	MLR Not Met	Rebates due for small group with MAMSI Life and Health Insurance Company, and for large group with UnitedHealthcare Insurance Company and UnitedHealthcare of the Mid-Atlantic, Inc. View the 2024 Medical Loss Ratio Final Payout Report	Begins mid-Sept, with all sent by Sept 30	Employer
UnitedHealthcare Virginia	MLR Met	MLR Not Met	MLR Not Met	Rebates due for small group UnitedHealthcare Plan of the River Valley, Inc and MAMSI Life and Health Insurance Company, and for large group with Optimum Choice, Inc.. View the 2024 Medical Loss Ratio Final Payout Report	Begins mid-Sept, with all sent by Sept 30	Employer

CARRIER	MLR RESULT			DESCRIPTION OF REBATE	REBATES
	IFP	SMALL GROUP	LARGE GROUP		MAILED BY	SENT TO
Aetna Connecticut, New York	MLR Met	MLR Met	MLR Met	No rebates will be issued	-	-
Anthem Connecticut	MLR Met	MLR Not Met	MLR Met	Rebates due for Anthem Health Plans, Inc.	Sept 30	Employer
Anthem New York	MLR Met	MLR Met	MLR Met	No rebates will be issued	-	-
Cigna + Oscar Connecticut	Carrier will not release results			-	-	-
EmblemHealth New York	Carrier will not release results			-	-	-
Healthfirst	Carrier will not release results			-	-	-
Oscar New York	Carrier will not release results			-	-	-
Oxford Connecticut	-	MLR Met	MLR Met	No rebates will be issued. View the 2024 Medical Loss Ratio Final Payout Report	-	-
Oxford New York	-	MLR Met	MLR Not Met	Rebates due for Oxford Health Insurance Inc. View the 2024 Medical Loss Ratio Final Payout Report	Begins mid-Sept, with all sent by Sept 30	Employer
UnitedHealthcare Connecticut	-	MLR Met	MLR Met	No rebates will be issued. View the 2024 Medical Loss Ratio Final Payout Report	-	-
UnitedHealthcare New York	-	MLR Not Met	MLR Not Met	Rebates due for UnitedHealthcare Insurance Company of New York. View the 2024 Medical Loss Ratio Final Payout Report	Begins mid-Sept, with all sent by Sept 30	Employer

* The following carrier is not subject to MLR: HealthPass. Refer to the enrolled carrier for results.

Visit the CMS website to search historical MLR filings by carrier and year.

Employers should be aware that although employers are not required to send a specific notice regarding the rebate to employees, insurance carriers are required to send notices of rebates to plan participants. The notices sent by carriers will not include the amount of the rebate, but will state that the rebate was sent to the employer and that a portion may be distributed to participants.

Although there are no specific notice requirements for employers, it may be worthwhile to send an employee communication that clarifies whether, and how, employees can expect to receive their portion of the rebate. Employers may also want to point out that the rebate will usually be a relatively small amount on a per-participant basis. Employees may incorrectly assume that they will be receiving a significant rebate based on only the information included in the carrier notices.

Related Article: How Employers Should Handle MLR Rebates

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