August 2023 Market Edge News for Small Group Business

2022 Federal MLR rebates to be issued to group policyholders by September 30

AmeriHealth’s federal Medical Loss Ratio (MLR) in 2022 was below the required minimum for AmeriHealth Insurance Company of New Jersey small groups. As a result, we will issue affected customers a rebate of a portion of paid premiums during the 2022 reporting year.

Check and notification mailings by September 30

Before the end of September, AmeriHealth will mail impacted group customers their rebate checks. Included with each check are a required CMS notice, cover letter, and FAQ. Group rebates will be distributed at the plan level, so customers may receive more than one rebate check if they offered more than one plan for 2022.

In addition, as required by CMS, group subscribers will also 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, as well as groups that are no longer in business, will receive rebate checks directly.)

Here are samples of the letters and notice we are sending to groups and subscribers:

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 market. If the MLR falls below 80 percent, customers are entitled to a refund of a portion of their premium.

If you have any questions, please contact your account representative.