Tuesday, July 16, 2013

Medical Loss Ratio (MLR) Rebates

Beginning in June and by August 1st, health care providers will be mailing rebate notices and checks to policyholders and subscribers whose plans are due a rebate under the Minimum Medical Loss Ratio provision of the Affordable Care Act. The provision in the ACA requires health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement, which is otherwise known as the Medical Loss Ratio (MLR). This MLR requires insurance companies to spend at least 80% or 85% of premium dollars on medical care.

In most cases, for group plans, the rebate checks will be sent directly to the policyholder. Some insurance issuers will have satisfied the MLR requirements and will not be issuing rebate checks. Your Senn Dunn consultant will advise you on the handling of these rebates.

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