Thursday, March 10, 2011

UHC survey mailed to fully insured customers to collect data for medical loss ratio provision

Provisions of the Affordable Care Act (ACA) calling for a specific medical loss ratio (MLR) for the small and large group markets require UnitedHealthcare (UHC) to survey customers to get data on the total number of employees to help determine the applicable MLR.

Beginning March 7, 2011, a mailing will go to all fully insured customers requesting “the average number of employees as employed by the employer’s company during the preceding calendar year,” using the federal definition. The survey, which can be done online with a secure access code, asks for the employee count by month for all 12 months.

For each MLR reporting year, a health insurance issuer must provide a rebate to the employer and each enrollee if the issuer’s MLR does not meet or exceed the minimum MLR percentage established in the law:
• 80 percent for individual and small group markets.
• 85 percent for the large group market.

The regulation defines small group as 1 to 100 and large group as 101+.

Customers will have 30 days from receipt of the mailing in which to respond to the survey. For those without online access, a form that can be faxed in response will be included with the mailing.

This data will be used to appropriately segment the group into the large or small group market according to federal guidelines and could have ramifications for rebate potential in 2012.

Going forward, this data must be gathered and reported annually in order to comply with the ACA regulation and provide any applicable rebates in a timely manner.

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