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
Client Alert | 4 min read | 04.23.26
Bipartisan Coalition of State AGs Backs Federal PBM Transparency Rule
In mid-April, a bipartisan coalition of 45 State Attorneys General (AG) submitted a formal letter to the U.S. Department of Labor (DOL) expressing their collective support for a proposed rule (Improving Transparency into Pharmacy Benefit Manager Fee Disclosure, or RIN 1210-AB37), which would — if enacted — impose new disclosure obligations on pharmacy benefit managers (PBM) regulated under the Employee Retirement Income Security Act of 1974 (ERISA).
Client Alert | 5 min read | 04.23.26
Client Alert | 3 min read | 04.23.26
Crowell Tracker of Court Rulings on Legal Privilege and Artificial Intelligence Tools
Client Alert | 2 min read | 04.23.26
Two Lawsuits in One: The Growing Risk of Pairing Biometric Tech With Wage-and-Hour Violations
