Medical Loss Ratio Rebates

HHS Issues Final Notice of Benefit
and Payment Parameters for 2016

The ACA’s medical loss ratio (MLR) rules require health insurance issuers to spend 80 to 85 percent of their premium dollars on medical care and health care quality improvement activities, or pay rebates to enrollees.

The final rule requires that subscribers of nonfederal governmental or other group health plans not subject to ERISA receive the benefit of MLR rebates within three months of receipt of the rebate by their group policyholder, just as subscribers of group health plans subject to ERISA do. In addition, the final rule includes technical clarifications to ensure that issuers correctly exclude federal and state employment taxes, as well as the cost-sharing reduction payments issuers receive from HHS, from MLR and rebate calculations.

On Feb. 27, 2015, the Department of Health and Human Services (HHS) published its final Notice of Benefit and Payment Parameters for 2016. This final rule describes benefit and payment parameters applicable to the 2016 benefit year, including standards relating to:

     • The reinsurance program’s annual contribution rate for 2016.

     • The 2016 open enrollment period.

     • The 2016 annual limitations on cost-sharing.

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