IBX Logo February 2023 News about Fully Insured Groups

Additional MLR rebates for 2020 to be issued to some policyholders

Starting this week, Independence Blue Cross (Independence) will be issuing an additional medical loss ratio (MLR) rebate to affected customers and subscribers for a portion of their 2020 health insurance premiums. The check mailing will continue until the end of February.

The additional rebate is being issued following a clarification on MLR calculation provided by the Centers for Medicare & Medicaid Services (CMS). As a result of the clarification, we looked at prior year calculations and determined an additional amount was due for 2020. Any applicable interest has been included in the amount of each check.

Since the rebate is an additional amount based on a recalculation, the same segments that originally received a rebate for 2020 will receive checks. The following subscribers and customers are receiving rebates:

  • QCC individual subscribers and small and large group fully insured customers
  • Keystone Health Plan East (KHPE) large group fully insured customers
  • AmeriHealth PA large group fully insured customers

In addition, the recalculation showed that KHPE small group customers were due rebates for 2020, so customers in that segment will now receive a rebate.

Included with each check is a cover letter and FAQ document. KHPE small group customers will also receive a CMS notice since that segment was not included in the original 2020 MLR rebate. And, as required by CMS, KHPE small group subscribers will also receive notification that their group/employer is receiving a rebate.

All MLR rebates are distributed at the plan level, so customers may receive more than one rebate check if they offered more than one plan for 2020.

About MLR rebates

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.

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.

Customer service is available

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:

  • Independence and AmeriHealth PA customers (as well as brokers) may call 1-888-379-7435.
  • Independence subscribers may call 1-888-745-2314.
  • AmeriHealth PA subscribers may call 1-888-379-7435.

Impacted parties can also visit cms.gov for more information about MLR requirements.