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Early Warning MLR Report Shows Affected States and Groups

Story Content Provided by UnitedHealthcare on 5/20/13

UnitedHealthcare's Early Warning Report forecasts the states, legal entities and group sizes (each combination of which we call an Aggregation Set) that are currently eligible to be issued MLR premium rebates by UnitedHealthcare associated with the 2012 calendar year. Any owed rebates will be paid in July, 2013. For MLR purposes, "state" means the situs state of the contract, not necessarily the state where the business has its main operations. 

The Report shows that 54 UnitedHealthcare fully-insured group Aggregation Sets in 29 states, the District of Columbia and the Virgin Islands are forecasted to receive an MLR premium rebate. Preliminary results in terms of the total group Aggregation Sets potentially eligible (54) closely mirror last year's results (56), although there is some variation among the actual states, legal entities and group sizes.

In the Small Group category, the Early Warning Report forecasts that rebates could be paid in 26 Aggregation Sets in 17 states, the District of Columbia and the Virgin Islands. Currently, 28 Large Group Aggregation Sets in 21 states and the District of Columbia are showing eligibility to receive a rebate. 

Eight states and the District of Columbia have rebate eligible Aggregation Sets in both Small Group and Large Group: Arizona, Arkansas, Florida, Mississippi, Missouri, Nebraska, North Carolina and Oklahoma.

There are 21 states and two territories in which UnitedHealthcare does not currently anticipate paying any rebates associated with group business: Alabama, Connecticut, Delaware, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Minnesota, Montana, New Hampshire, New Mexico, North Dakota, Ohio, Oregon, Pennsylvania, Texas, Vermont, Washington, Wyoming, Guam and Puerto Rico.

Until 2016, Small Group for MLR purposes is generally defined as 1 to 50 average total number of employees (ATNE) during the in the year proceeding the applicable MLR reporting year, except that states may choose to use an upper limit of 100. When calculating group size, all employees are to be counted, including full time, part time, and seasonal employees. After 2016, current regulations require that Small Group be defined as 1-100 ATNE for MLR purposes.

There are 38 states that define "Small Group" as having between 1-50 ATNE, while 12 states and the Virgin Islands use the definition of 1-100. Large Group is defined as above the state limit for Small Group.

Remember that each insurer does its own computations. As such, customers may hear that rebates are being paid in their state or states, but UnitedHealthcare might not be one of the companies liable for rebates in that location.

The data in the Early Warning Report is a preliminary forecast only and could potentially change before final results are filed with the Department of Health and Human Services on June 1, 2013. The forecast offers a reasonable expectation of what might happen only and should not be interpreted as UnitedHealthcare's final position for calendar year 2012.

Unlike last year, notices are being sent only to policyholders receiving rebates and to their subscribers. Those policyholders not receiving a rebate from UnitedHealthcare and their subscribers won't receive any notice from us this year.