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An update for our brokers in CT, DE, MA, ME, NJ, NY, PA, RI, VT and WV Aetna will mail letters to some plan sponsors about MLR

We want to let you know about letters we are sending to some of your plan sponsors. These letters concern health care reform and the minimum medical loss ratio (MLR).   As you know, the Affordable Care Act sets rules on how much plans must spend each year on medical care and activities that improve health care quality.  These rules address the minimum medical loss ratio, or MLR.   If an issuer/insurer does not spend the minimum amount required by law, they must provide a premium rebate. The minimum required is different for small group and large group plans. So we need to make sure we are placing each plan sponsor in the right category.   If you have questions about these letters, please contact your Aetna representative.   Here is some information about how we will ask for information from plan sponsors (policyholders) and discuss MLR rebates. Plan sponsors with 200 or fewer employees enrolled with Aetna On January 20, 2016, a mailing will target plan sponsors with fewer than 200 enrolled with insured medical products. This includes all Coventry customers and Aetna customers renewing January – March 2016.  All other Aetna customers will receive an updated enrollment verification form asking for total average employees (TAE) before they receive their 2016 renewal.    These letters request a total average employee count for calendar year 2015. We will use this information to place the plan sponsor in an MLR pool (large group or small group). Then we will use the pool for MLR reporting and rebate administration for the 2016 experience year. We will report and make rebate payments for the 2016 experience year in 2017.   This mailing is like the letter we sent to plan sponsors of this size in November 2014 to collect their 2014 TAE count.  Plan sponsors can respond through an online portal, which can be accessed through aetna.com. Or they can return a paper response card in the provided postage-paid envelope. We’ll send them specific instructions on how to access the portal in their letter. And we’re asking them to respond by March 31, 2016.

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