The Texas Department of Insurance will define a “large employer” as an employer with at least 101 employees for purposes of applying the new federal medical loss ratio (MLR) reporting and rebate rules.

Texas Insurance Commissioner Mike Geeslin talks about the small employer and large employer definitions in Commissioner’s Bulletin Number B-0028-11.

Geeslin issued the bulletin to help Texas health insurers implement the MLR provisions of the Patient Protection and Affordable Care Act of 2010 (PPACA), which require insurers to spend 85% of large group revenue and 80% of individual and small group premium revenue on health care and quality improvement efforts.

Interim regulations adopted by the U.S. Department of Health and Human Services (HHS) define a “small employer” as “having an average of at least 1 but not more than 100 employees on business days during the preceding calendar year.”

The HHS regulations define a “large employer” as “having an average of at least 101 employees on business days during the preceding calendar year.”

Until 2016, a state can substitute “50 employees” for “100 employees” in the definition of “small employer” and “51 employees” for “101 employees” in the definition of “large employer,” Geeslin writes in the bulletin.

In Texas, the exceptions that would lead the state to define a small employer as one having 50 or fewer employees and a large employer as one having 51 or more employees do not apply, Geeslin says.

“Therefore, for MLR purposes, the department will apply the HHS definition for ‘small employer,’” Geeslin says.

- Allison Bell

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