Urgent care visits to soar due to PPACA
July 6, 2012
Source: www.benefitspro.com
Urgent care visits will likely see a considerable boost due to the Supreme Court ruling on the Patient Protection and Affordable Care Act.
“Although urgent care isn’t specifically mentioned anywhere in the legislation, the open access that all urgent care centers have should make them a natural entry point for the newly insured—especially in areas where many primary care practices aren’t accepting new patients,” says Lou Ellen Horwitz, executive director of Urgent Care Association of America.
The law’s mandate targets the roughly 16 percent of uninsured Americans, equating to another 50 million Americans who could be seeking medical care, Horwitz says.
Urgent care centers, on average, see 342 patient visits per week. This equates to more than160 million patient visits each year. The Supreme Court ruling will drive an increase in volume as these new patients may see urgent cares as an alternative to the emergency room, Horwitz says.
“Fortunately, the industry continues to expand and should have capacity to accept these patients with relative ease in most areas,” she says.
There are about 9,000 urgent care centers in the country, but less “full-fledged” urgent care centers (those offering lab and x-ray, open 7 days a week), at 4,500.
New Guidelines On Obesity Treatment Herald Changes In Coverage
By Michelle Andrews
July 10, 2012
Source: Kaiser Health News
Eat less, exercise more. Simple? Yes. Easy? No. If weight loss were easy, obesity rates among adults in the United States probably wouldn't have reached the current 36 percent.
Recently revised guidelines from the U.S. Preventive Services Task Force acknowledge that fact. They recommend that clinicians screen patients for obesity, which is defined as having a body mass index of 30 or higher. Further, they say patients who meet or exceed that level should be offered or referred to "intensive, multicomponent behavioral interventions" to help them lose weight.
The revised guidelines strengthen the previous recommendations, says David Grossman, a senior investigator at Group Health Research Institute in Seattle and a member of the task force.
For the millions of people who struggle to lose weight, the new guidelines offer much-needed support. It's unclear whether employers and insurers will welcome the change, though.
Under the 2010 health-care law, new health plans and those whose benefits change enough to lose their grandfathered status must provide services recommended by the Preventive Services Task Force at no cost to members. For the 70 percent of employers that already offer weight management programs, that may mean just supplementing what they already offer, says Russell Robbins, a senior clinical consultant at Mercer, a human resources consulting firm.
But some employers are concerned they may be on the hook for ongoing treatment as employees make repeated attempts to lose weight.
"From a financial standpoint, the guidelines are pretty broad and pretty extensive," says Helen Darling, president of the National Business Group on Health, which represents the interests of large firms. "Does this mean that employers and the government will be paying for up to 26 intense visits every year for every obese person for the rest of their lives?"
An HHS official said the department is evaluating whether to issue additional guidance on the new rules.
Insurers will be working to determine how best to satisfy the recommendations, says Susan Pisano, a spokeswoman for America's Health Insurance Plans, an industry group.
"I think the real question is making sure there are programs that fulfill these requirements," she says.
According to the task force, effective weight-loss programs involve 12 to 26 group or individual sessions over the course of a year that cover multiple behavioral management techniques. These may include setting weight-loss goals and strategizing about how to maintain lifestyle changes, incorporating exercise and eating a more healthful diet, and learning to address the psychological and other barriers that create roadblocks to weight loss. The task force found that people in these programs generally lost nine to 15 pounds in the first year.
The task force said there wasn't enough evidence to determine whether such interventions worked for people who were overweight but not obese.
A number of existing programs provide the kind of care that the guidelines recommend, say experts.
Weight Watchers, for example, runs 20,000 meetings a week around the country where people discuss their weight-loss challenges and successes and get pointers on losing weight and keeping it off.
At $42.95 a month for access to group meetings and online food tracking and other tools, however, it's not an option for many people with limited incomes, who make up a disproportionate share of the obese. Some employers subsidize their employees' membership in the program. Under the new guidelines, insurers and employers could be responsible for paying 100 percent of the cost.
Other programs have also been successful. Two years ago, the Centers for Disease Control and Prevention, in partnership with UnitedHealth Group and the YMCA, launched the National Diabetes Prevention Program for people at high risk for developing Type 2 diabetes.
The program is based on a study in which participants who learned to eat more healthfully and exercised at least 150 minutes a week lost 5 to 7 percent of their weight and reduced their risk of developing diabetes by 58 percent.
The program is offered by many YMCAs and other groups. It offers each participant 16 weekly group weight-loss sessions followed by six monthly sessions. It's a covered benefit for people with UnitedHealthcare or Medica insurance; others pay based on a sliding scale, says Ann Albright, director of CDC's Division of Diabetes Translation. CDC is working with Medicaid and Medicare to try to get it covered by those programs, says Albright.
John Joseph IV tipped the scales at 203 and had a BMI of 28.3 when he paid $150 to join the program at the YMCA near his Birmingham, Ala., home. In the four months since then, the 34-year-old, who runs a job-coaching business for college grads, has dropped 17 pounds.
At the weekly group meetings, he learned to count the fat grams in food and to make smarter food choices. Now he eats fewer cookies and more flounder. He started an exercise program and runs or lifts weights for 30 minutes three times a week.
"I thought, if I can do this, it will give me the infrastructure and habits so I can get to the mid-170s, which is where I want to be," he says.
Losing weight is hard, but keeping it off may be harder.
In 2009, Gayenell Magwood lost 100 pounds with the help of the weight management center at the Medical University of South Carolina in Charleston.
But after health problems curtailed her exercise routine for a few months, her weight crept up to 170, a gain of nearly 20 pounds. Magwood, 49, who lives in North Charleston and is a researcher in the College of Nursing at MUSC, went through the 15-week program all over again, at a cost of about $600. She lost the weight she had regained.
Before enrolling in the MUSC program, "I'd never once been successful with significant weight loss," she says.
House plans five-hour debate on healthcare repeal, WH warns veto
By Pete Kasperowicz
Source: thehill.com/blogs
The House will hold five hours of debate today and Wednesday on legislation that would completely repeal the 2010 healthcare law, which is being called up by Republicans in light of the Supreme Court's decision that the individual health insurance mandate is constitutional.
The House Rules Committee approved a rule late Monday setting out the lengthy debate on a bill that is expected to pass with Republican support, but very little if any Democratic support. The Repeal of Obamacare Act, H.R. 6079, was formally introduced by House Majority Leader Eric Cantor (R-Va.) on Monday.
Later Monday evening, the White House put out a statement saying President Obama would veto the bill if it were presented for his signature, something that won't happen given Senate opposition.
"The Administration strongly opposes House passage of H.R. 6079 because it would cost millions of hard-working middle class families the security of affordable health coverage and care they deserve," the statement said. "It would increase the deficit and detract from the work the Congress needs to do to focus on the economy and create jobs.
"The last thing the Congress should do is refight old political battles and take a massive step backward by repealing basic protections that provide security for the middle class, it added. "Right now, the Congress needs to work together to focus on the economy and creating jobs. Congress should act on the President's concrete plans to create an economy built to last by reducing the deficit in a balanced way and investing in education, clean energy, innovation, and infrastructure.
"If the President were presented with H.R. 6079, he would veto it."
Under the rule for the House bill, the House Committees on Education and the Workforce, Energy and Commerce, and Ways and Means will each control one hour of debate. House Committees on Budget, Judiciary and Small Business will each control 30 minutes.
Finally, Majority Leader Cantor and House Minority Leader Nancy Pelosi (D-Calif.) and/or their designees will split the last 30 minutes of debate time.
The House is expected to start work on the bill by debating and approving the rule, which will take an hour early this afternoon. A final vote on passage on the bill itself is expected Wednesday.
IFEBP survey: More than 75% of sectors will provide health coverage in 2014
By Marli D. Riggs
July 2, 2012
Source: https://eba.benefitnews.com
Despite the differing reactions among U.S. business sectors to last week’s Patient Protection and Affordable Care Act Supreme Court ruling, 77% of surveyed organizations are very likely to provide health coverage in 2014, according to a recent survey by the International Foundation of Employee Benefits Plans.Following the Supreme Court’s decision, almost half (49%) of the organizations are shifting their attention to wellness, while 32% are focusing on consumer-driven health plans, 27% will shift costs to employees and 26% will focus on value-based health care, according to The Supreme Court ACA Decision Reaction Survey.
“We’re not surprised by these findings since our recent wellness survey told us that seven in 10 U.S. employers offer wellness programs,” says Paul Hackleman, IFEBP’s health care and public employer analyst.
Overall, the results were split when respondents identified which Supreme Court decision would have been most beneficial to their organization. The data showed that 46% felt the best possible decision for their organization would have been PPACA being thrown out, while 41% said the best decision was the law being upheld. Another 12% of organizations would have liked the individual mandate overturned, but the remainder of the health care law to stay intact.
Most organizations have been keeping current with the legislative aspects of PPACA and some are already prepared for provisions in the future. Of the respondents 78% are extremely or very far along in terms of complying with current PPACA provisions, while 60% are extremely or very far along with preparing for future provisions.
Further, organizations in states that have already implemented health care exchanges are generally more satisfied with the Court’s decision (47% to 35% of respondents in states that haven’t implemented), and are more prepared with current provisions (47% to 36%) and more likely to continue coverage in 2014 (56% to 42%).
The survey was administered on June 28 to measure organizations’ reactions to the landmark decision. Responses were received from 1,122 plan administrators, trustees and organizational representatives.
Businesses won't wait for elections before implementing health law
By Sam Baker
July 9, 2012
Source: thehilll.com/blogs/healthwatch
Most businesses waited for the Supreme Court before making plans to comply with President Obama’s healthcare law — but most aren’t waiting for November to see whether the law might be repealed.
A new survey from the consulting firm Mercer found that most businesses have not begun planning for requirements that will take effect in 2014, including the mandate requiring employers to provide health benefits to most workers.
Businesses said they were holding off on implementation until they knew whether the Supreme Court would strike down the healthcare law — the same approach many Republican governors have taken. But now that the court has upheld the law, only 16 percent of the employers in Mercer’s survey said they plan to wait for November and the prospect of legislative repeal.
Mercer surveyed 4,000 businesses immediately following the high court’s decision.
The National Federation of Independent Business (NFIB), the country’s largest small-business organization, joined 26 state attorneys general in filing the legal challenge to the Affordable Care Act. Republicans consistently argue that the law will burden small employers and stifle new hiring.
But only 28 percent of the employers in Mercer’s survey said the new employer mandate will pose a “significant challenge.” The law requires many businesses to offer healthcare coverage or pay a penalty for all workers who buy coverage on their own, with help from the federal government.
“Employers with large part-time populations, such as retailers and healthcare organizations, are faced with the difficult choice of either increasing the number of employees eligible for coverage or changing their workforce strategy so that employees work fewer hours,” said David Rahill, president of Mercer’s Health and Benefits business.
How can company policies prevent injury?
Source: https://www.riskandinsurance.com
Implementing, enforcing policies can improve bottom line, study suggests
Prescription drug abuse, texting, and falls by older adults are among the emerging injury threats cited in a new study. It suggests policymakers and others implement and enforce policies to reduce preventable injuries.
More than $400 billion is spent annually in lifetime costs for medical care and lost productivity resulting from injuries. While the report focuses on steps states can take to prevent injuries, the recommendations are also appropriate for employers trying to reduce workers' comp costs and improve their bottom lines.
Injuries are the third-leading cause of deaths nationally, according to the researchers. Among the most common types are:
- Falls. "More than eight million Americans suffer falls that require medical attention each year," it says. One in three people age 65 and older experiences a fall annually, and falls are the leading cause of injury deaths in adults over 65 years of age. Falls can be reduced "by as much as half" among participants involved in exercise programs.
- Violence. Injuries caused by intimate partners alone cause more than 2,000 deaths a year. Nearly three in 10 women and one in 10 men have experienced physical violence, rape, or stalking by a partner.
- Misuse and abuse of prescription drugs. The report notes the dramatic increase in the past decade, saying prescription painkillers are responsible for approximately 15,000 deaths and 475,000 emergency room visits a year.
For employers, injuries mean lost productivity as well as increased workers' comp and health care costs. Adults between the ages of 25 and 44 comprise 30 percent of the U.S. population but account for 44 percent of injury-related productivity losses.
Overall, businesses lose $326 billion in productivity annually due to injuries. Motor vehicle and other road-related accidents are responsible for $75 billion of the total while falls account for $54 billion, and struck by or against costs $37 billion.
"Many injuries are predictable, preventable and controllable," according to the study. "For instance, researchers found that seat belts can greatly reduce the harm caused to individuals in motor vehicle crashes."
The study, The Facts Hurt: A State-by-State Injury Prevention Policy Report, cites research showing seat belts saved an estimated 69,000 lives between 2006 and 2010. However, 18 states do not have primary seat belt laws.
Thirty-one states do not require helmets for all motorcycle riders, although research says they saved an estimated 8,000 lives from 2005 to 2009.
The researchers ranked the states in terms of their injury prevention efforts based on 10 key indicators. They included whether the state has enacted a prescription drug monitoring program, whether it has a primary seat belt law, and whether it requires a helmet for all motorcycle riders.
California and New York received the highest score while Montana and Ohio netted the lowest.
"Millions of injuries could be prevented each year if more states adopted additional research-based prevention policies and if programs were fully implemented and enforced," the report says.
"We could dramatically bring down rates of injuries from motor vehicles, assaults, falls, fires and a range of other risks even more if more states adopted, enforced and implemented proven policies," said Amber Williams, executive director of the Safe States Alliance. Hers was one of several groups that teamed up with the Trust for America's Health and the Robert Wood Johnson Foundation for the study.
The Long Arm Of The U.S. Healthcare Ruling
Source: https://www.insurancebroadcasting.com
The Supreme Court ruling to uphold the core of President Barack Obama's 2010 healthcare law has wide-ranging political and economic implications.
Here is a snap analysis of what it means for Americans, healthcare providers, insurers, the law and the presidential campaign.
How does the ruling affect the average American?
* Working families with annual household incomes up to nearly $90,000 will be able to purchase private insurance through new state insurance markets at prices subsidized according to income level, beginning in 2014. But people with household incomes of around $29,000, who qualify for coverage under the Medicaid government health insurance program for the poor, may have to wait for their respective state governments to decide whether they will join the program's huge expansion. Preventive healthcare measures including mammograms and other cancer screenings will be available without deductibles or co-pays. Adult children up to age 26 can remain on their parents' health insurance plans. Senior citizens can expect to continue receiving discounts on prescription drugs aimed at closing the Medicare coverage gap known as the "doughnut hole." Health insurers will continue to pay rebates on premiums not sufficiently targeted at healthcare services. Beginning in 2014, insurers will no longer be able to deny coverage to adults with pre-existing medical conditions and would be required to stop or curb discriminatory pricing based on gender, age and health status.
What about healthcare providers?
* The ruling removes one cloud of uncertainty over the future of healthcare reform and would help the administration's efforts to implement it fully by January 1, 2014, when the law is scheduled to go into effect. Under the decision, physicians and hospitals continue to move away from the traditional fee-for-service healthcare business model and toward more efficient systems that coordinate care. For healthcare providers, the affirmation represents millions of potential new patients, either through private plans or the government's Medicaid program for the poor. Some, however, would be under added pressure to enact more savings, which could cut into revenues. The administration still faces some fairly tall hurdles, such as establishing regulated health insurance markets in all 50 states so consumers can purchase subsidized coverage. Up until now, over a dozen states have done little or nothing to create such exchanges, partly because of the uncertainty over the fate of the law. Down the road, if Republicans succeed in taking control of the White House and the Senate in November (they already control the House of Representatives), they would likely try to repeal the law in 2013.
Where does the ruling leave health insurers?
* The health insurance industry can expect premium revenue from millions of new, healthy customers through state exchanges. But the industry will also have to operate with new consumer protections that require coverage access for people with pre-existing medical conditions and other health status issues, and mandate preventive care without customary charges.
How might the ruling influence the presidential campaign?
* This is a big victory for Obama, who has weathered years of criticism from conservatives about his reforms. The decision could energize the president and his supporters, while undercutting presumptive Republican presidential nominee Mitt Romney, who introduced similar reforms as Massachusetts governor but opposes their use as national policy. But there could be a silver lining for Republicans: the opinion could light a fire under party candidates and constituents who want a president who would repeal the law in 2013.
(Reporting by David Morgan and Lewis Krauskopf; Editing by Michele Gershberg and Will Dunham)
Workforce Obesity: What Can You Do?
| Source: https://safetydailyadvisor.blr.com
What can you do to help workers maintain a healthy weight and keep your bottom line healthy at the same time? Read about a company that's helping its workers lose tons of weight. |
| Employees of Health Care Services Corporation (HCSC) lost more than 53,000 pounds last year. HCSC is the owner and operator of Blue Cross Blue Shield of Illinois, Texas, Oklahoma, and New Mexico.
According to Senior Vice President Dr. Paul Handel, that amount tops the company’s 20-ton weight-loss goal. A robust wellness program including fitness centers, classes, and healthy cafeteria food are part of the solution. "Many employers have viewed wellness programs as a nice extra when times are flush," says Handel. "We believe that the obesity epidemic and the rising toll of diabetes now make them a strategic imperative." Financial incentives are an important part of the HCSC strategy. In addition to tying wellness to annual bonuses, the company offers employees additional incentives of up to $200 a year for taking an annual wellness exam and logging their physical activity. Great news! BLR's renowned Safety.BLR.com® website now has even more timesaving features.
Other StrategiesThe key to achieving and maintaining a healthy weight, says the Center for Disease Control and Prevention (CDC), isn't about short-term dietary changes. It's about a lifestyle that includes: · Healthy eating; · Regular physical activity; and · Balancing the number of calories consumed with the number of calories the body uses. According to CDC the first step in maintaining a healthy weight is to look at the current situation. Body Mass Index (BMI) is one way to measure weight. BMI calculations are based on height and weight: · A BMI of 18.5 signifies being underweight. · The range between 18.5 and 24.4 is considered to be a normal weight. · The range between 24.5 and 29.9 is considered to be overweight. · A BMI between 30 and 40 is considered to be obese. · BMI of 40 and greater is considered to be morbid or extreme obesity. Your employees can calculate their BMI by going to |
Wellness programs could mitigate projected 2013 health care cost increases
By David Morgan
May 31, 2012
Source: https://eba.benefitnews.com
The cost of U.S. health care services is expected to rise 7.5% in 2013, more than three times the projected rates for U.S. inflation and economic growth, according to an industry research report from PricewaterhouseCoopers.
But premiums for large employer-sponsored health plans could increase by only 5.5% as a result of company wellness programs and a growing trend toward plans that impose higher insurance costs on workers, the firm concluded.
The projected growth rate of 7.5% for overall health care costs contrasts with expectations for growth of 2.4% in U.S. gross domestic product and a 2% rise in consumer prices during 2013, according to the latest Reuters economic survey.
Health care costs have long been known to outstrip economic growth and inflation rates, driving up government spending on programs such as Medicare and Medicaid at a time when federal policymakers and lawmakers are wrangling over how to trim the U.S. budget deficit of $1 trillion a year.
But PwC's Health Research Institute, which based its research on input from health plan actuaries, industry leaders, analyst reports and employer surveys, said data for the past three years suggest an extended slowdown in healthcare inflation from earlier decades when annual costs rose by double-digits.
"We're in the early beginnings of a shift toward consumerism in health care. And we think that you'll see more of that in the coming months and years," said Ceci Connolly, the health institute's managing director.
More than half of the 1,400 employers surveyed by the firm are considering increasing their employees' share of health care costand expanding health and wellness programs in 2013, according to the report.
Connolly said health plans with higher deductibles and co-pays for workers tend to dissuade unnecessary purchases and offer lower premium costs for employers, while successful wellness programs can reduce the need for medical services.
The report said prospects for higher growth are also being held back by the consolidation of hospitals and physician practices, insurance industry pressure on hospital expenses, a growing variety of primary care options such as workplace and retail health clinics, price transparency and the increasing use of generic drugs.
Upward pressure on health care costs comes in part from a rebounding economy and the growth of new medical technologies, including robotic surgery and the nuclear medicine imaging technique known as positron emission tomography.
PwC's projection of 7.5% growth is nearly double a 3.9% rise in U.S. health care spending that the federal government says occurred in 2010, the last year for which official figures are available.
OVERVIEW OF MEDICAL LOSS RATIO REBATES
The Affordable Care Act requires health insurers to spend a minimum percentage of their premium dollars on medical claims and quality improvement. Insurers in the large group market must achieve a medical loss ratio (MLR) of 85%, while insurers in the individual and small group markets must achieve an MLR of 80%. Insurers that fail to achieve these percentages must issue rebates to their policyholders. The first of these MLR rebates are due in August of 2012, so plan sponsors should begin planning how to handle any rebates they might receive.
Which Plans Are Covered?
The MLR rules apply to all fully insured health plans (even grandfathered plans). Self-funded plans are exempt. Certain types of insured coverage, such as fixed indemnity, stand-alone dental and vision, and long-term disability, are also exempt.
If a rebate is payable to a group policyholder, the insurer must issue a single rebate check to the plan. The plan sponsor must then decide whether and how to pass the rebate on to the plan's participants.
Calculating a Medical Loss Ratio
The calculation of an MLR is not specific to each policyholder, but is a state-by-state aggregate of the insurer's overall MLR within a particular market segment (e.g., individual, small group, or large group). Thus, even if a specific employer plan has a low MLR (i.e., favorable claims experience), the employer may not necessarily receive a rebate.
States are permitted to set higher MLR targets. In those states, insurers must comply with the more stringent state requirements.
Notices to Subscribers
Insurers must send written notices to their subscribers, informing them that a rebate will be issued. Plan sponsors should be prepared to respond to questions from participants who receive these notices, particularly if the sponsor does not intend to share any of the rebate with those participants.
Likewise, even if an insurer meets the MLR requirements, it must notify subscribers that no rebate will be issued. This notice must be included with the first plan document provided to enrollees on or after July 1, 2012. Model notices<https://cciio.cms.gov/programs/marketreforms/mlr/index.html> are available on the Centers for Medicare & Medicaid Services website.
How to Allocate MLR Rebates
The Department of Labor (DOL) issued Technical Release 2011-04<https://www.dol.gov/ebsa/newsroom/tr11-04.html>, summarizing how ERISA plan sponsors should handle MLR rebates. To the extent that all or a portion of the rebate constitutes a "plan asset," the sponsor may have a fiduciary duty to share the rebate with plan participants.
In the absence of specific plan or policy language, the determination of whether an MLR rebate is considered to be a plan asset will depend, in part, on the identity of the group policyholder. If the plan or trust is the policyholder, the MLR rebate will likely be considered a plan asset under ordinary notions of property rights.
However, if the employer is the policyholder, the determination will hinge on the source of the premium payments and the percentage of premiums paid by the employer, as opposed to plan participants. If the premiums were paid entirely out of plan assets, the DOL's view is that the entire amount of the rebate would be considered a plan asset. In other circumstances, only the portion of the rebate that is attributable to participant contributions will be considered a plan asset.
If all or a portion of a rebate does constitute a plan asset, then the plan sponsor will have to determine how and to whom to allocate the rebate. For example, must a portion of the rebate be allocated to former plan participants? The selection of an allocation method must be reasonable and it must be made solely in the interest of plan participants and beneficiaries.
However, a plan fiduciary may weigh the costs to the plan - and the ultimate plan benefit - when deciding on an allocation method. Thus, for example, if the cost of calculating and distributing shares of a rebate to former participants approximates (or exceeds) the amount of the proceeds, a fiduciary is permitted to limit the allocation to current plan participants.
Similarly, if it is not cost-effective to distribute cash payments to plan participants (because the amounts are de minimis, or they would produce negative tax consequences for the participants), a fiduciary may use the rebate for other permissible plan purposes. These might include a credit against future participant premium payments or benefit enhancements.
Tax Consequences
Before deciding to pass an MLR rebate on to participants, a plan sponsor will want to understand the tax implications of doing so. The IRS has issued a set of questions and answers<https://www.irs.gov/newsroom/article/0,,id=256167,00.html> on this topic. Because this guidance is entirely in the form of examples, with few general principles provided, the tax treatment may not always be clear. What is clear is that a number of factors will affect the taxability of an MLR rebate.
For individual policyholders receiving an MLR rebate, the IRS treats the rebate as a return of premiums (i.e., a purchase price adjustment). As long as the premium payments were not deducted on the individual's federal tax return, the MLR rebate should not be taxable. However, if an individual did deduct the premium payments, the MLR rebate will be taxable to the extent the individual received a tax benefit from that deduction.
For participants in a group plan, the tax consequences will depend on factors such as the source of the premium payments (employer versus participant), whether participant premiums were paid on an after-tax or pre-tax basis, and whether a participant who paid premiums on an after-tax basis later deducted those premiums on his or her federal income tax return.
Another key factor is whether the rebates are passed through only to participants who participated in the plan during both the year to which the rebate relates and the year it is received, or to all participants who participate during the year the rebate is received (i.e., without regard to whether they also participated during the year to which the rebate relates).
For instance, if a participant paid premiums on an after-tax basis and the MLR rebate is specifically conditioned on the participant having participated in the plan during both the year to which the rebate relates and the year it is received, any rebate allocated to that participant will generally not be taxable - regardless of whether the rebate takes the form of a cash payment or a reduction in future premium payments. However, if the participant claimed a tax deduction for the premium payments (as might be the case for a self-employed individual), the rebate will be taxable to that participant.
On the other hand, if an MLR rebate is passed through to all current plan participants (regardless of whether they participated in the plan during the year to which the rebate relates), the rebate should not be taxable even if a participant took a tax deduction for premiums paid during that year.
Finally, if a participant paid premiums on a pre-tax basis (i.e., through a cafeteria plan), the return of those premiums - whether received in cash or as a credit against future premiums - will be subject to both income and employment taxes.