Am I getting a check in the mail? Medical Loss Ratio Rebate Update

The Affordable Care Act requires insurance companies to spend a certain percentage of the premiums they collect on medical services & programs that directly benefit their insureds. If an insurance company fails to meet this requirement by not spending enough on medical benefits, they must issue a refund to the policyholders during the summer of the following plan year.  This is known as a Medical Loss Ratio Rebate.

These calculations are based on a number of aggregated factors, including the type of plan (small group, large group, or individual) and the state where the plan is set up.

Rebates for the 2013 plan year have already started. Below you will find general rebate information received from the different insurance companies for Arizona policyholders:

Company                                                                   Rebate?
HealthNet                                                                    None
BCBSAZ                                                                        Small Group only
Aetna                                                                            Yes
United HealthCare (Small Group)                           No
Aetna (Small Group)                                               HMO plans only
Assurant Health                                                        Small Group Only
IHC Health Solutions                                              Small Group Only

Individuals and families receiving a rebate may use it as they wish.

Employers, on the other hand, must spend the rebate for the benefit of the plan participants in a fair and equitable manner .  Contact us for recommendations on how to do this properly.


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