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Under the Affordable Care Act, insurance companies and HMOs must report their Medical Loss Ratio to ensure that they are providing value to their members. If they fail to meet a particular threshold, which means claims were less than expected for a given year, they pay a rebate to individual consumers or employer groups.
MLR is a basic financial measurement used in the Affordable Care Act (ACA) to encourage health plans to provide value to members. If an insurer or HMO uses 80 cents out of every premium dollar to pay for customers’ medical claims and activities that improve the quality of health care, the company has an MLR of 80%. This means the insurer is using the remaining 20 cents of each premium dollar to pay for overhead expenses. The ACA sets a minimum MLR for employer-provided plans or individual plans. Read on for more details.
If a rebate is due:
Those who buy their own coverage from Florida Blue or the Marketplace will automatically get a check or a premium credit. You don’t have to request one. To check if you are receiving an MLR refund this year, look under Savings Accounts & Rebates on the My Plan page of your account at floridablue.com. You’ll see a message there and, if you’re eligible, your rebate amount will also appear. This information is usually available by mid-September.
Members who get their coverage through their job will get a letter saying that their employer is getting a rebate. However, federal law requires that insurers pay rebates directly to their employer group and the employer is responsible for determining how to best use the rebate. Please contact your employer or Benefit Administrator for more details.