The Department of Health and Human Services issued a statement last week, saying the agency will exercise the discretion of Secretary Kathleen Sebelius under new health reform law to address the special circumstances of limited benefit plans in medical loss ratio calculations.
Federal MLR requirements have not officially been issued, and recommendations from the National Association of Insurance Commissioners are due by Dec 31.
The MLR guidance issue is of great concern to companies employing a high proportion of part-time, seasonal and temporary workers who are enrolled in limited medical benefit (mini-med) plans because they are ineligible for coverage under their employer's regular group health care plan. Most of these mini-med plans don't meet a 2011 requirement that they spend 80 percent to 85 percent of premiums on medical benefits instead of administration expenses.
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