The Affordable Care Act (ACA) requires Blue Shield of California and other health insurance carriers to spend a minimum percentage of plan members’ premium on medical expenses, known as the “Medical Loss Ratio” standard or the “80/20 rule.” The 80/20 rule in the Affordable Care Act is intended to ensure that consumers get value for their healthcare dollars.
The Medical Loss Ratio reporting and rebate requirements apply to all fully insured group and individual commercial plans, including grandfathered plans. They do not apply to self-funded (ASO) business, Shared Advantage, or Medicare Supplemental plans.
We are now collecting employer information to calculate 2022 MLR rebates through March 31, 2023. Group plan sponsors with <150 employees should receive a link to this short survey, requesting information on average employee count in 2021 and basic group plan sponsor information. To access the survey, please use the Group ID and the following web key: #44n50c. Group plan sponsors may also submit this information by faxing back the print survey form. If you have any questions regarding the MLR Employer Survey, please contact us at MLRAssist@blueshieldca.com or call us at (800) 325-5166.
Blue Shield of California (Blue Shield) does not owe Medical Loss Ratio rebates for 2021 to the following subscribers and employer groups since Blue Shield met or exceeded the MLR targets for those health plans.
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