[UCRDBR] United Healthcare – Optum Health Insurance Premium Rebate Letter

[Departmental Benefits Representatives]

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October 5, 2020

To:          Department Benefits Representatives (DBRs)
From:      HR Benefits Office
Re:          United Healthcare – Optum Health Insurance Premium Rebate Letter
2019 Kaiser Permanente (KP) plan members recently received the UnitedHealthcare (Unimerica) Health Insurance Premium Rebate Letter<https://hr.ucr.edu/document/optum-health-insurance-premium-rebate-letter>. KP plan members received this letter because they had Optum Behavioral Health benefits coverage in 2019. Optum was legally required to send the communication to its members by September 30, 2020.

The Affordable Care Act requires insurance companies to use a certain amount of premium dollars to provide services. If the full amount is not used, the excess must be reimbursed as a rebate to the employer, and plan members must be notified of the rebate. Unfortunately, Optum did not provide UC advance notice of the rebate, nor did they inform UC they would be noticing members.

UC is considering the options available for using rebates returned to an employer because the group health plan did not meet the Medical Loss Ratio (MLR) requirements of the Affordable Care Act.  Employees should not assume that they would receive a rebate directly. Upon determination, we will inform you of UC’s decision as well as provide an FAQ for impacted members’ reference on UCnet.


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