DOL and HHS Issue Guidance on Medical Loss Ratio Rebates

On December 2, 2011, the DOL issued Technical Release 2011-04 concurrently with HHS issuance of an Interim Final Rule regarding Medical Loss Ratio (MLR) rebates. The Interim Final Rule appeared in the December 7, 2011 Federal Register and requests comments no later than February 6, 2012.  The HHS guidance is expressed in terms of "subscribers" while the DOL guidance addresses ERISA group health plans.  If you provide health benefits via insurance, it's time to review your plan document language as it relates to rebates.

The TR notes that just because the plan sponsor is the policyholder doesn't automatically mean the plan sponsor is entitled to the rebate. The terms of the governing plan documents are critical in determining who is entitled to the rebate.

If you think you  might receive a rebate next year, check your plan documents!

For more details read our ErisaALERT.