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Customers Surveyed for 2013 MLR Calculation
September 10, 2012
To comply with the Medical Loss Ratio (MLR) provisions of the Affordable Care Act, we are surveying customers to obtain data on the Average Total Number of Employees (ATNE) to determine the applicable group market size needed for the MLR calculation.
Beginning Sept. 20, 2012*, a mailing will go to all fully insured customers with more than 5 and fewer than 150 employees covered by the applicable UnitedHealthcare policy requesting the average number of employees employed during 2011.
The health reform law established a definition of “small employer” as those with 1 to 100 employees; however, it also allowed states to define “small employer” as 1 to 50 employees until 2016.
To arrive at the appropriate employee count, employers must include all full-time, part-time and seasonal workers in all divisions of the company, regardless of where the employee is located. An employee is typically any person for whom the company issues a W-2, whether or not they had or were eligible for medical coverage.
The survey, which can be done online with a secure access code, asks for the employee count by month for all 12 months. Customers must enter the total number of employees for each month of 2011, regardless of whether they had coverage with UnitedHealthcare for the full year or were in business but did not offer health coverage.
Customers will have 30 days from receipt of the mailing in which to respond to the survey. For those without online access, a form and postage-paid return envelope are enclosed with the mailing. Our MLR Operations team will conduct telephonic follow up on non-responders.
This data will be used to appropriately define each group policy as either large or small for purposes of MLR rebate calculations. Failure to respond to the survey will result in UnitedHealthcare having to rely on subscriber numbers, which may not be the same as total employees.
ATNE data is a crucial component of MLR rebate calculations. Customers are strongly encouraged to respond promptly and accurately to the ATNE survey.
*Mailings will be staggered to spread out the call volume for the service teams.
Jan. 1, 2015 PDL Updates
Updates will take place on UnitedHealthcare’s Advantage and Traditional Prescription Drug Lists (PDLs), the the SignatureValue Formulary, and OptumRx direct business on Jan. 1, 2015. Learn more
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