Beginning in March 2026, Anthem will issue additional Medical Loss Ratio (MLR) rebate checks to certain employer groups and Individual members in California, Colorado, Maine, New Hampshire, and Virginia.
These incremental rebates stem from two factors:
- Adjustments were required after Anthem received federal ACA claim subsidy dollars following original rebate payments for 2018 and 2019 Individual business in New Hampshire, Maine, and Virginia.
- Minor discrepancies identified during regulatory MLR examinations resulted in updated rebate calculations for 2021 business in New Hampshire (Individual, Small Group, and Large Group), Colorado (Small Group), and California (Large Group).
As a reminder, the MLR provision of the Affordable Care Act (ACA) requires health plans to spend the majority of premium dollars on medical care and quality improvement activities rather than administrative costs. Fully Insured Individual and Small Group plans must meet an 80% MLR standard, while fully insured Large Group plans must meet an 85% standard. When those thresholds are not met, carriers are required to issue rebates. ASO and stop-loss plans are not subject to MLR rebate rules.
Rebate checks will be mailed in March 2026 and will include a federally mandated notice explaining how MLR is calculated. Employers receiving rebates are also required to notify covered employees.
Employers who receive MLR rebates under the ACA are not automatically required to pay the full rebate amount directly to employees — but they may be required to share part of it, depending on how premiums were paid. This is subject to Employee Retirement Income Security Act (ERISA) and Department of Labor (DOL) rules.
Under ACA guidelines, employers must distribute rebate funds within three months of receipt. Funds may be shared proportionally with employees enrolled in the rebated plan or applied toward future premium reductions. For ERISA-governed plans, rebate dollars may also be used to offset current plan premiums.
For additional details, please review the MLR Rebate FAQ. As always, reach out to your Anthem representative with any questions.