|
September 2021
|
Market Edge
|
|
News for All Segments | AHNJ
|
2020 Federal MLR rebates to be issued to group policyholders by September 30
|
|
AmeriHealth New Jersey's federal Medical Loss Ratio (MLR) in 2020 was below the required minimums for small and large group fully insured AmeriHealth Insurance Company of New Jersey, as well as large group fully insured AmeriHealth HMO, Inc. As a result, we will issue affected customers (those with EPO, HMO, PPO, POS, and POS+ plans) a refund of a portion of paid premiums during the 2020 reporting year.
|
Check and notification mailing to begin week of September 20
|
|
Beginning the week of September 20, AmeriHealth New Jersey will mail impacted customers their rebate checks. Each mailing will include a required CMS notice and a cover letter and FAQ.
|
|
Beginning the week of September 27, group subscribers will receive notification that their group/employer is receiving a rebate. (Subscribers that are part of groups that are ERISA exempt but did not provide proper verification, and groups that are no longer in business, will receive rebates directly.)
|
|
Here are samples of the notices and letters we are sending to groups and subscribers:
|
|
|
|
The MLR report is available in the sales portal under Broker Reports.
|
|
Please note that the refund for groups is being distributed at the plan level, so groups may receive more than one refund check if they offered more than one plan for 2020.
|
|
The Affordable Care Act requires health insurance companies maintain an MLR (percentage of a premium dollar used for medical claims) of 80 percent (or 80 cents of every premium dollar) in the small group and 85 percent in the large group employer markets. If the MLR falls below 80 or 85 percent, customers are entitled to a refund of a portion of their premium.
|
|
If you have any questions, please contact your AmeriHealth New Jersey broker representative.
|
