Insights

Changes to definition of “small employer” and “large employer” for purposes of MLR


In February 2017, the Ohio Department of Insurance issued Bulletin No. 2017-02, amending the definition of “small employer” for purposes of the MLR requirement pursuant to passage of the PACE Act. In light of the PACE Act’s passage, and since Ohio law is currently consistent with federal law (as amended) for the 2017 reporting year, Ohio defines “small employers” as those who employ on average 1-50 employees on business days during the preceding calendar year. “Large employers” will be defined as those who employed an average of at least 51 employees on business days during the preceding calendar year.

As background, a bulletin issued by CMS clarified that issuers may use the definition of 50 employees as the upper threshold, rather than 100 employees, for purposes of MLR rebates. However, subsequent guidance issued by CMS on Dec. 17, 2015, (see article in the Jan. 12, 2016, edition of Compliance Corner) allowed states to delay implementation of the lower threshold until the 2017 reporting year.

This bulletin is effective Jan. 1, 2017.

Bulletin No. 2017-02 »