OPM Publishes FAQ on FEHBP Medical Loss Ratio
Client Alert | 1 min read | 08.30.12
The U.S. Office of Personnel Management (OPM) published a letter and FAQ for federal employees regarding the ACA-mandated Medical Loss Ratio (MLR) for Federal Employees Health Benefits Program (FEHBP) plans in an August 22, 2012 Benefits Administration Letter. The FAQ explains the basic framework of the MLR standard and clarifies that:
- whether an FEHBP plan owes a rebate is determined based on all of a carrier’s line of business (e.g., large group) within a given state;
- any rebated owed by an FEHBP plan shall be paid directly to OPM, the policyholder for all FEHBP plans, as required by FAR §31.201;
- any rebate paid by an FEHBP plan shall be deposited into the contingency reserve of that health plan and shall be used to directly reduce the cost of the next year’s premiums for that plan; and
- FEHBP enrollees will receive a notice from their plan indicating whether the plan did or did not meet the MLR standard.
Insights
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Sixth Circuit Finds EFAA Arbitration Bar to Entire Case — Not Just Sexual Harassment Claims
The United States Court of Appeals for the Sixth Circuit held, in an issue of first impression for that court, that the Ending Forced Arbitration of Sexual Assault and Sexual Harassment Act of 2021 (EFAA) renders an employer’s pre-dispute arbitration agreement unenforceable as to a plaintiff's entire lawsuit, whenever the lawsuit includes a viable sexual harassment claim.
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