Blue Cross and Blue Shield of Illinois

 

 

June 21, 2013

Legislative Update
BCBSIL Meets/Exceeds 2012 MLR Standards

The operator of Blue Cross and Blue Shield of Illinois (BCBSIL) filed its Medical Loss Ratio (MLR) report with the U.S. Department of Health & Human Services (HHS) for the 2012 MLR reporting year, per the Affordable Care Act (ACA).

BCBSIL met or exceeded the MLR standards for all applicable Illinois market segments for the 2012 MLR reporting year. As a result, BCBSIL will not be issuing any MLR rebates in those markets.

Reminder: What Is MLR?
In general, MLR is the percentage of insurance premium dollars spent on reimbursement for clinical services or medical expenses and activities to improve health care quality. ACA sets MLR standards for different markets. If an insurer’s MLR does not meet or exceed the MLR standard for a certain market of a state, they may have to issue rebates to enrollees.

The MLR standard for the large group market is 85 percent, and the MLR standards for small group and individual markets are 80 percent (ACA’s MLR standards do not apply for self-funded group health plans.)

MLR Notices
Last year, HHS required that a “Notice 4” be provided to certain enrollees who would not receive a rebate for the 2011 MLR reporting year. This notice is not required for the 2012 MLR reporting year and, therefore, will not be mailed.

Please contact your broker and/or BCBSIL account representative with questions.

 

 
.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association.