MLR FAQs for subscribers

• If you had individual coverage in a market segment where Tufts Health Plan did not meet the MLR requirement, then Tufts Health Plan will issue a rebate check or premium credit.
• If you had employer group coverage in a market segment where Tufts Health Plan did not meet the MLR requirement, then Tufts Health Plan will issue your employer a rebate check or premium credit.

• If you had individual coverage in a market segment where Tufts Health Plan did not meet the MLR requirement, then Tufts Health Plan will issue a rebate check.  
• If you had employer group coverage in a market segment where Tufts Health Plan did not meet the MLR requirement, then Tufts Health Plan will issue your employer a rebate check.  

Massachusetts state and/or Federal MLR rebates and notification letters will be sent to employer groups and individuals, postmarked by August 31, 2023.

Your rebate represents the difference between what Tufts Health Plan anticipated (the rates set in advance of 2022, which were based on the most current data at that time), and what was actually spent, in terms of your health care premium. You’re getting money back this year because the medical costs for 2022 were lower than projected.

MLR rebates are calculated using the following formula:

Clinical Services + Quality Improvement Expenses
________________________________________
Earned Premium ― (Taxes and Fees)

The rebate calculated as shown above is based on a combination of factors, including legal entity, state and group size, within a particular business segment. It is not based on any one customer’s services and expenses.    

Quality improvement activities are designed to improve the quality of care received by the health plan member. The intended improvements must be tracked and must also be measurable and verifiable by objective standards. Examples of quality improvement activities and programs:   

• Reducing medical errors 
• Preventing hospital readmissions
• Reducing health disparities
• Promoting wellness and healthy lifestyle habits 

Learn more about Tufts Health Plan’s quality programs.

No, only individuals who will be receiving an MLR rebate for 2022 will be notified.

Yes. We will send a notice to enrolled subscribers whose employers are receiving a federal rebate postmarked no later than August 31, 2023.

If your group health plan is subject to the Federal Employee Retirement Income Security Act of 1974 (ERISA), your employer may have fiduciary responsibilities regarding use of the MLR rebates. Some or all of the entire rebate may be an asset of the plan, which must be used for the benefit of the employees covered by the policy. For general information about your employer’s responsibilities regarding the rebate, ask your benefits administrator or your Human Resources department.

It will be your employer’s responsibility to distribute the rebate to their employees according to Department of Labor rebate regulations.