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MLR Premium Rebate Checks Begin Mailing

September 5, 2017

For benefit plan year 2016, the sixth Medical Loss Ratio (MLR) reporting year, UnitedHealthcare’s results show 49 aggregation sets (40 group and 9 individual combined) qualified to receive premium rebates totaling $114,954,917. For a summary of which states, legal entities and size of business (aggregation set) will be receiving a rebate, refer to the Final Rebate Summary Report

Final customer-specific results were verified in early September 2017. Prior to mailing checks, final rebate reports were provided to UnitedHealthcare sales and account management, brokers and consultants to assist customers with any questions regarding their eligibility for a rebate in September. The reports include the amount of rebate owed and paid as well as the MLR percentage achieved by the aggregation set in which the policyholder was grouped. Following is a table that shows aggregate sets and premium rebates over the past three years: 

 

2016

2015

2014

Aggregation Sets

 

 

 

Group Business

40

49

53

Individual Business

9

14

23

Total

49

63

76

 

 

 

 

Premium Rebates

$114,954,917

$105,712,174

$117,626,280

Premium rebate checks began to go out in September and will be staggered over a three-week period. All required payments are expected to be received by the September 30 deadline. 

Primarily, rebates will be paid to the applicable policyholder. In a limited number of cases where a group policyholder written assurance was required but not received, the subscribers of those groups will receive the premium rebate checks. In addition to the checks mailing to policyholders, notices of the rebate also will be mailed to the subscribers of those group policyholders receiving a rebate. 

Support
Brokers and customers can call the Broker/Employer service line at (866) 802-8602 if they have questions related to the rebate payout. 

Background
MLR applies to fully insured group commercial plans and individual plans. The law requires insurers to spend a minimum percentage of premium dollars (80 percent for individual and small group (1-50, or 1-100 depending on the market) markets and 85 percent for large group (51+ or 101+ depending on the market) on medical services and activities designed to improve health care quality. For 2016 rebate reporting year, the following 13 states define small group as 1 – 100 and large group as 101+: Alaska, Arkansas, California, Colorado, Florida, Louisiana, Nebraska, New York, Ohio, Tennessee, Texas, Utah and Wisconsin.  The Year 6 calendar year began on Jan. 1, 2016. 

MLR is based on legal entity, state and size of employer. Payouts are based on an aggregate —not on the performance of a specific employer group or individual. An aggregation set is the combination of situs state, legal entity and group size. For more information, refer to the list of states by employer size and legal entity or your specific customer reports on United eServices®.

January 1, 2017 PDL Updates


The following updates will take effect for the OptumRx direct Prescription Drug Lists (PDLs) on January 1, 2017. Learn more

New Sales Automation Management Tool


Check out our new Sales Automation Management (SAM). Learn more

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