Harvard Pilgrim Health Care of Massachusetts Announces Medical Loss Rato Rebates

Posted 08.10.23

As a result of State and Federal laws that introduced Medical Loss Ratio (MLR) requirements, Harvard Pilgrim Health Care (HPHC) is required to rebate a portion of insurance premiums received in 2022 if they did not spend at least 88% of small group & 85% of large group funds on health care for members.

HPHC’s calculations have determined that Massachusetts-based fully insured commercial HMO and PPO products in 2022 are eligible for a rebate.

In compliance with Massachusetts state and Federal MLR standards, Massachusetts small group employers will receive a rebate check from HPHC postmarked by August 31, 2023. No rebates will be issued for Massachusetts large groups, as the 2022 threshold was met for this segment.

2022 Massachusetts Small Group Results
For 2022, HPHC spent 87.2% of a total of $411,849,103 in premium dollars on health care and activities to improve health care quality. Since these costs came in under the 88% small group target by 0.8% of premiums received, HPHC must rebate 0.8% of the total health insurance premiums paid by the employers and employees in these group health plans.

Notification Letters Are Being Mailed

HPHC will send notification letters to affected employers postmarked no later than August 31, 2023. Employers will be responsible for distributing the rebate to their enrolled employees.

HPHC will also send notification letters to qualified subscribers whose employer is receiving a rebate, postmarked no later than August 31, 2023. The letter will go to employees who were active members as of December 31, 2022 (or, if applicable, as of the date that the group plan terminated coverage in 2022).

HPHC’s intermediary partners will issue rebates, either as checks or premium credits on invoices, for those groups covered through an Intermediary.

For Tufts Health Plan Groups That Have Migrated to Harvard Pilgrim
Please be aware that if an employer group migrated from Tufts Health Plan to HPHC and is due a rebate for 2022, they will receive their rebate from Tufts Health Plan, since their premium was paid to Tufts Health Plan.

More Information Online
Visit  2022 MLR Rebate Information page for:

  • Copies of the letters being sent to employers and subscribers
  • FAQs for employers and subscribers, which include more details about MLR rebates and potential methods for disbursing these rebates to employees

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