MLR Notices and Rebates – Aetna



MLR notices and rebates

Beginning in June and by August 1st, Aetna is scheduled to mail rebate notices and checks to policyholders and subscribers whose plans are due a rebate under the Minimum Medical Loss Ratio provision of the Affordable Care Act. For group plans, rebate checks will be sent to the policyholder, with few exceptions.

In this second year of MLR reporting, Aetna’s rebates represent 0.2 percent of the premiums we collected. This year we will pay out $27.8 million for the 2012 experience year. This total is significantly lower than last year and is a clear indication that we met our goal—to price our business so that we deliver the greatest value to our customers, remain competitive in the market and grow our business. The rebates we are paying are modest, and most policyholders won’t receive a rebate at all. We want to explain the mailings that some of your customers may be receiving.

Each mailing will include the government-required notice of health insurance premium rebate, as well as a letter from Aetna. For rebate checks sent to the policyholder; the government has issued rules on how policyholder may use the rebates. In certain circumstances, Aetna will distribute the rebate to the subscribers instead of the policyholder. This happens if:

  • The policyholder has terminated and we are not able to locate them, or
  • A non-ERISA/non-government policyholder failed to provide the required written assurance that it would use the rebate payment according to the government rules.

The federal government set guidelines that group employers or policyholders are required to follow when using rebate dollars. It is up to those group employers or policyholders to use these rebates according to the law. We have provided an overview of some of these guidelines for group employers or policyholders

The overview provides information your policyholder needs to know about the Minimum MLR provision. We are not providing legal advice and suggest that policyholders work with their legal counsel to decide how you will use the rebate.

Targeted mail schedule

Audience Timing
Wave 1 Individual subscribers with checks Beginning June 19
Wave 2 Plan sponsors with and without checks BeginningJune 27
Wave 3 Group subscribers without checks BeginningJuly 2
Wave 4 Group subscribers with checks BeginningJuly 5

MLR rebates will be distributed by August 1, 2013.

List of employees request process

To request a list of employees in impacted pools (roster) on behalf of your impacted policyholder call the MLR service center 1-855-697-7509 between 8:00 a.m. and 8:00 p.m. Eastern time, Mondaythrough Friday. You will need to provide the policyholder address and validate certain information.

There are two options for the policyholder to receive the list of employees, email or hard copy. If email is requested, it will go “send secure” from mailbox and include instructions on how to open the message for viewing.

How will the pool information appear in the Aetna letter?

MLR Pool=the area defined by size, legal entity and state where Aetna is paying a rebate.

  • Size=Individual, small group or large group
  • Legal Entity=HMO / AHI (Aetna Health Insurance) or ALIC (Aetna Life Insurance Company)
  • State=for MLR purposes state is based on contract situs state

Sample Required Notice of Health Insurance Premium Rebate Letters and Aetna cover letters:

MLR Pool=the area defined by size, legal entity and state where Aetna is paying a rebate.

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