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Independence’s federal Medical Loss Ratio (MLR) in 2020 was below the required minimums for individual, small and large group fully‑insured QCC, as well as both large group fully insured Keystone Health Plan East and AmeriHealth PA businesses in Pennsylvania. As a result, we will issue affected customers a rebate of a portion of paid premiums during the 2020 reporting year.
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Check and notification mailing to begin
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Beginning the week of September 27, Independence will mail impacted customers their rebate checks. Each mailing will include a required CMS notice and a cover letter and FAQ.
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Also the week of September 27, we will mail individual subscribers their rebate checks. In addition, 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.)
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Here are samples of the notices and letters we are sending to groups and subscribers:
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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.
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The Affordable Care Act requires that all health insurers spend a percentage of each premium dollar received towards paying claims, clinical services, and activities that improve health care quality for members. This percentage is known as the minimum Medical Loss Ratio.
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If a health insurer does not meet this MLR requirement, the insurer is required by law to issue rebates to employer groups and/or plan subscribers. As a reminder, self‑funded commercial group health plans are not subject to MLR rules.
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Our dedicated MLR customer service team will be prepared to help assist customers and subscribers with any MLR rebate‑related questions and are available via these helplines:
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- Independence and AmeriHealth PA customers as well as brokers may call 1‑888‑379‑7435 to speak with a dedicated customer service representative about their rebate check, CMS notice, or letter and FAQ.
- Independence subscribers may call 1‑888‑745‑2314 to speak with a dedicated member services representative about the CMS notice, letter and FAQ.
- AmeriHealth PA subscribers may call 1‑888‑379‑7435 to speak with a dedicated member services representative about the CMS notice, letter and FAQ.
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Impacted parties can also visit cms.gov for more information about MLR requirements.
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