Rule: In­sur­ers must re­port meet­ing MLR tar­get

Modern Healthcare - - LATE NEWS -

Health in­sur­ance com­pa­nies that meet or ex­ceed the med­i­cal-loss-ra­tio stan­dard es­tab­lished in the health­care re­form law must no­tify pol­i­cy­hold­ers on or af­ter July 1, ac­cord­ing to a new rule from the CMS. The MLR stan­dard is a con­sumer pro­tec­tion in the Pa­tient Pro­tec­tion and Af­ford­able Care Act that re­quires in­di­vid­ual and small-group plans to spend at least 80 cents of ev­ery pre­mium dol­lar on med­i­cal care. In­sur­ance com­pa­nies that do not meet the stan­dard for cov­er­age pro­vided in 2011 are ob­li­gated to send re­bates to em­ploy­ers and in­di­vid­u­als by no later than Aug. 1 of this year. Un­der the new rule, HHS will also re­quire com­pa­nies to in­form pol­i­cy­hold­ers when they do clear the hur­dle. The no­tice may be sent in the same mail­ing with other no­tices— and may be pro­vided elec­tron­i­cally—but it must be dis­played in 14-point, bold type on the front of the plan doc­u­ment, in­sur­ance pol­icy or certificate, or in a sep­a­rate no­tice, the reg­u­la­tion noted. “If your in­sur­ance com­pany is pro­vid­ing fair value for your pre­mium dol­lars, you should know that too,” HHS Sec­re­tary Kath­leen Se­be­lius said in a blog post.

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