Medical Loss Ratio Letter Mailing to Groups and Members
Excellus BlueCross BlueShield exceeded the federal medical loss ratio (MLR) standards last year, so we are not required to rebate premium for 2011. While we exceeded the standards, federal regulation does require that we send a one-time notice with information about MLR. Those notices will be mailed to our group administrators for all insured groups the week of October 8.
Employers are being instructed through this mailing to distribute the required MLR information notice to their employees. We are also providing employers with a letter explaining why they are receiving this notice when no refund is required. These materials can be shared in hard copy with their next distribution of plan documents (such as benefit summaries), and should be sent no later than June 30, 2013. A copy of the notice and the letter are posted in the Resources section of our Health Care Reform web page (under Medical Loss Ratio)
Federal standards, as they apply to New York state insurance customers, set the minimum level of benefits to be 82 percent of premium revenues in the small group market and 85 percent for large groups. In 2011, Excellus BlueCross BlueShield spent 90.9 percent of premium revenues on medical benefits for small and large groups. This means that $255 million more was spent on hospital and physician services, prescriptions and other medical benefits than federal and state standards required in 2011 under the provisions of the federal Patient Protection and Affordable Care Act.
If you have any questions or need additional information, please contact your Account Consultant.
View sample Employer & Member/Employee Letters and the MLR Notice in the Resources section of our Health Care Reform web page (under Medical Loss Ratio)