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Medical Loss Ratio Rebate Information

National health reform law (Affordable Care Act or ACA) and Massachusetts law require health insurers to spend a minimum percentage of premium dollars on medical expenses, referred to as medical loss ratio or MLR. If a minimum MLR is not met in a particular market segment, the insurer is required to provide a premium rebate to the customers in that market segment.

The minimum MLR thresholds under the federal law are 85% for large group business and 80% for small group and individual business. Massachusetts has a separate minimum MLR rebate threshold, 90%, for the MA merged market (small groups under 51 benefit eligible employees and most non-group plans).

Insurers were required to report their MA Merged Market MLR calculations with the Massachusetts Division of Insurance on May 31, 2013, and their federal MLR calculations with Health and Human Services (HHS) on June 1, 2013. Applicable MA Merged Market rebates need to be issued by June 30, 2013 and federal rebates by August 1, 2013.

Neighborhood Health Plan will issue rebates for 2012

Neighborhood Health Plan will be issuing 2012 premium rebates to the Massachusetts merged market at the end of June and to large group employers under the federal Affordable Care Act at the end of July.

News and updates on health care reform for employers

NHP statement on Supreme Court's ruling on the Affordable Care Act (ACA), Thursday, June 28, 2012

We at Neighborhood Health Plan applaud the Supreme Court's ruling to uphold the Affordable Care Act (ACA). The ACA validates the principle we stand by: to ensure that all Americans have access to affordable, equitable, quality health care.
Many of the consumer protections included in the ACA are already in place in Massachusetts, including guaranteeing access to coverage regardless of health status and ensuring renewal of coverage regardless of medical history. There are a few provisions of the ACA that we'd like to highlight:
  • Individual Mandate - This upheld provision requires that Americans have health insurance or pay a penalty. This mandate is already in place in Massachusetts and is a critical component in the effort to make health insurance accessible and affordable for everyone.
  • Coverage for Young Adults - The ACA ensures health insurance coverage for young adults to age 26.
  • Medicaid Expansion - Medicaid expansion within the health reform law is wonderful news for low-income families. The Court’s ruling that allows states to opt out of the expansion is unfortunate; yet highly unlikely to impact the course that Massachusetts is taking.
  • Community Health Centers - The ruling means that the significant investments made in community health centers in the ACA will continue and recognizes the critical role that community health centers play in expanding access and establishing a medical home for millions of Americans.
As a trusted source of affordable, comprehensive care for diverse communities, Neighborhood Health Plan will continue to ensure access to coverage for Massachusetts residents. We will continue to focus on making health care work better for our employer customers, members, and providers by developing innovative models that will help to bend the health care cost curve, ensure the delivery of high-quality care, improve care coordination, and deliver value in health care benefits.