Friday, October 21, 2011

BCBSNC to mail employers survey for medical loss ratio reporting

The Patient Protection and Affordable Care Act (ACA) requires health insurance issuers to submit a medical loss ratio (MLR) report to the Department of Health and Human Services annually beginning June 2012, and requires the insurer to issue rebates if the MLR is less than the applicable percentage established in the ACA. ACA requires a minimum MLR of 80% for individual and small group plans and a minimum of 85% for large group plans.

BCBSNC currently classifies plans based on number of eligible employees. Plans with eligible employees of up to 50 are classified as small groups, consistent with state law. Per recent federal guidance, BCBSNC must determine group size when calculating MLR by averaging the total number of all employees employed on any business day during the preceding calendar year. This includes each full-time, part-time and seasonal employee that receives a W-2 and excludes temporary employees and consultants with compensation reported on a 1099. This creates a need to collect group size information for MLR reporting purposes which differs from information BCBSNC collects for rating purposes.

Currently, BCBSNC does not collect data on ineligible employees, such as part-time or seasonal workers. To obtain this information, BCBSNC will send mailings to employers with 10 to 50 employees on their group plans, beginning on October 28th.

The instruction letter requests that the employer log into a website to complete the short survey. Or, the employer can complete the survey at the bottom of the letter and fax the letter back to BCBSNC.

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