HHS Issues Final Rules on MLR Notices
HHS Issues Final Rules on MLR Notices for Those Not Receiving Rebates
On May 11, 2012, the Department of Health and Human Services (HHS) issued final rules on the Medical Loss Ratio (MLR) rebate notices for policyholders and subscribers who are not receiving rebates.
Insurance companies and HMOs will not be required to communicate their specific MLR percent to those who are not receiving rebates. Instead, they must issue a new notice that says they have met or exceeded the minimum MLR standard. Policyholders and individuals who receive these notices will be directed to www.HealthCare.gov for information about their insurer’s actual MLR.
The notice to those not receiving rebates is required only for the 2011 rebates that will be issued in 2012. The purpose of sending it this year is to help educate consumers about MLR and direct them to the www.HealthCare.gov website for MLR information.
The notice must be provided with the first plan document (for example, open enrollment material) that is provided to enrollees on or after July 1, 2012. It may also be provided electronically.
This notice is not required for expatriate or mini-med policies where no rebate is due. In addition, for groups of policies with fewer than 1,000 participants where there is not enough credible data to determine if the MLR standard has been met, this notice is not required.
A copy of the new notice (Notice #4) is available at http://cciio.cms.gov/resources/files/Files2/2012-0511-medical-loss-ratio-information.pdf