Anthem groups and individual members in the following seven states will receive 2025 medical loss ratio (MLR) rebates:
- Colorado
- Georgia
- Indiana
- Missouri
- New Hampshire
- Ohio
- Virginia
The medical loss ratio (MLR) provision of the Affordable Care Act (ACA) requires health plans to spend most premium dollars on healthcare costs and quality improvement, rather than overhead. MLR compares insurance premiums to claims costs and is usually expressed as a percentage.
Fully insured small group and individual plans must spend at least 80% of premium income on healthcare claims and quality improvement. Fully insured large group plans must spend at least 85%. When a market does not meet the minimum ratio, rebates are issued to employer groups and individual policyholders. ASO plans and stop-loss insurance are excluded.
Employer groups and individual policyholders will receive a federally mandated notice with their rebate checks explaining MLR and how it is calculated.
We must also notify Anthem subscribers of groups that receive rebate checks.
ACA rules require employers to either distribute the rebate to employees covered by the rebated plan or use it to lower premiums in the next plan year. Policyholders must distribute rebates within three months of receiving them. Group plans subject to Employee Retirement Income Security Act (ERISA) laws may also use rebate funds to pay current plan premiums.
For more details on the rebates, view this FAQ.
Contact your Anthem representative with questions.