We want to let you know about letters we are sending to some of your plan sponsors. These letters are related to health care reform and the minimum medical loss ratio (MLR) requirements.

 

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 are the minimum medical loss ratio, or MLR requirements. If an issuer/insurer does not spend the minimum amount required under the law, they must provide a premium rebate. The minimum required is different for plans the government considers small group and for those it considers large group, so we need to make sure we are placing each plan sponsor in the appropriate category.

 

The following is information about how Coventry Health Plans will request information from plan sponsors (policyholders) and communicate with them about MLR rebates.

 

Plan sponsors with 200 or fewer employees enrolled with Coventry

 

In early April, Coventry Health plans will mail letters to all plan sponsors who have insured medical plans with 200 or fewer employees enrolled with Coventry. These letters request their MLR lives or total average employee count for calendar year 2013. We will use this information to place the plan sponsor in the appropriate MLR pool (large group or small group) for MLR reporting and rebate administration for the 2014 experience year. Reporting and payment of rebates for the 2014 experience year will occur in 2015. Two follow-up letters will be mailed to plan sponsors that do not respond to the initial request in mid/late April.

 

Coventry used to collect this information in the annual renewal questionnaire. Going forward, we will request the data separately.

 

Plan sponsors can return a paper response card in the provided postage-paid envelope. We're asking them to respond by 5/30/14. Two follow-up letters will be sent directly from us if they do not respond.

 

Duplicate plan sponsors between Aetna and Coventry

• There are about a half dozen plan sponsors that have both Aetna and Coventry plans. In these cases, Aetna will collect the TAE information from the plan sponsor and will apply it to both plans.
• A special letter will be mailed to the duplicate plan sponsors to advise them that their Aetna TAE (MLR lives) will be applied for Coventry plans.
• The letter will further instruct that if no TAE (MLR lives) was received in response to the Aetna outreach, then the TAE will default to average enrolled subscriber count unless the plan sponsor provides TAE within 10 days from receiving the letter.

 

Responding to questions

If you have questions about these mailings, please contact your Coventry representative. You can also learn more about MLR by going to our website at your convenience: www.healthreformplanMLR.com.

 

  

Sincerely,

Coventry Health Plans