Written Assurance Needed for Medical Loss Ratio Rebate Disbursement

You should have recently received a letter from Independence asking you to supply us with written assurance that certifies you, as the authorized representative of the plan, will use any Medical Loss Ratio (MLR) rebate paid to the plan to benefit your subscribers in one of the methods permitted under the final MLR rules.

Our records indicate that you may be a non-governmental Employee Retirement Income Security Act-exempt plan (ERISA-exempt). As outlined in the applicable Affordable Care Act regulation, if a non-governmental ERISA-exempt plan does not submit written assurance that they will use any rebate paid by their insurance carrier to benefit the plan’s individual subscribers, the insurer must distribute the rebate directly to the subscribers of the plan covered by the policy during the previous MLR reporting year.

How to Submit Your Information

Please submit this information within 10 days of receipt of your letter. If you fail to submit this information, any monies owed to you will be sent to your impacted subscribers instead.

By filling out and signing our brief and secure form below, you are verifying that you are an authorized representative of the employer and/or group health plan named on the form and that your organization will use any rebate paid to the plan to benefit impacted subscribers in one of the approved MLR methods.

Access the secure form.

Please visit healthcare.gov to learn more about MLR provisions.

If you have any questions, please contact your sales representative or broker.