Medical Loss Ratio Rebates

A few points to mention:

• This represents less than 10% of private health insurance consumers
• The average rebate is $151/family
• A small percentage will actually see a check b/c if you currently acquire your health insurance through your employer, the employer will get the insurance rebate check – however, most carriers are not wanting to issue checks, so they will be offering future savings instead of individual checks

On June 1, 2012 health insurance companies nationwide submitted their information in regards to Medical Loss Ratios.  Below is what this amounts to.

Because of the Affordable Care Act, insurance companies now must reveal how much of premium dollars they actually spend on health care and how much they spend on administration, such as salaries and marketing. This information was not shared with consumers in the past.  Not only is this information made available to consumers for the first time, If an insurance company spends less than 80% of premiums on medical care and quality (or less than 85% in the large group market, which is generally insurance provided through large employers), it must rebate the portion of premium dollars that exceeded this limit.^[1] This 80/20 rule is commonly known as the Medical Loss Ratio (MLR) rule.

On June 1, 2012, insurance companies nationwide submitted their annual MLR reports for coverage provided in 2011 to the Department of Health and Human Services (HHS). Based on this data, insurance companies that didn’t meet the 80/20 rule will provide nearly 12.8 million Americans with more than $1.1 billion in rebates this year. Americans receiving the rebate will benefit from an average rebate of $151 per household.

Under the new health care law, rebates must be paid by Aug. 1 each year. As a result, 12.8 million Americans will see one of the following:

• a rebate check in the mail
• a lump-sum reimbursement to the same account that was used to pay the premium if it was paid by credit card or debit card
• a direct reduction in their future premiums
• their employer providing one of the above rebate methods, or applying the rebate in a manner that benefits its employees.

Appendix II: Total Rebates by Market and State for Consumers and Families: Table shows state by state rebate data for the individual market, small group market, and large group market.

To see full results, here’s the link:

http://www.healthcare.gov/law/resources/reports/mlr-rebates06212012a.html