MLR (Medical Loss Ratio) Rebate Timeline

¿What is the Medical Loss Ratio Rebate?

Federal law, established as part of the Affordable Care Act in 2011, requires health insurers to spend majority of their premium dollars on medical claims and activities that improve health care quality.

Insurers must meet or exceed an MLR of 80 percent for the individual and small group markets, and 85 percent for the large group market. When insurers do not meet the MLR threshold, they must refund the difference to their customers via rebates.

¿Who can get an MLR rebate?

The MLR applies to fully insured plans/policies only. The 2018 payouts are for the 2017 MLR rebate reporting year, using the 2016 average total number of employees (ATNE) to determine MLR group size.

Small group size is 1 to 50 ATNE in all states except California, Colorado, New York and Vermont, where small group size is 1 to 100 ATNE. Payouts are based on the aggregation set, not on the performance of a specific employer group or individual.

The full MLR timeline is listed below:

July 31 – Health and Human Services (HHS) MLR Rebate Reports filed and publically available on in October
Week of Sept. 8 – Final rebate reports to insurance companies
Week of Sept. 15 – Final rebate reports to brokers on their specific customers
Sept. 30 – All MLR Rebate checks are mailed

Need help with your group health insurance? Contact us and we’ll be happy to help!