Aetna’s MLR Filing Continues to Demonstrate Appropriate Pricing

The Minimum Medical Loss Ratio (MLR) provision of the Affordable Care Act sets minimum percentages that health plans must spend on medical costs and quality improvement activities. Insurers file reports with the federal government detailing where they met the minimum, where they didn’t, and how much they will pay their insured customers in rebates.

In this eighth year of MLR reporting, Aetna (including Innovation Health and Coventry, subsidiaries, and affiliates) is paying rebates in some markets. The rebates are modest, and most policyholders/employers won’t receive a rebate at all. Refer to the list of MLR pools to see where rebates are being issued.

Aetna will send notices to subscribers and policyholders/employers of plans due a rebate by September 30, 2019. The amount of the check will depend on the total premiums paid by the customer in 2018. In most cases, for group plans, policyholders (plan sponsors/employers) will receive the plan’s rebate. In certain circumstances, the government has directed that the rebate is sent directly to subscribers of the group policyholders. This happens if:

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

Brokers may request a list of employees/roster on behalf of your impacted plan sponsor by calling the MLR service center at 1-855-697-7509 between 10:00 am and 6:30 pm EST, Monday through Friday. If you already indicated your plan sponsor would like an employee roster, you do not need to request another one. Only request an employee roster if your plan sponsor requests one. If an email roster was requested, it will be sent securely from the mailbox and will include instructions on how to open the message for viewing. The roster will be sent at the same time as the rebate check.