Under the Affordable Care Act, carriers are required to spend 80 cents of every premium dollar to pay claims, clinical services and activities that improve the quality of health care for members. This percentage is known as the minimum Medical Loss Ratio. If a health insurer does not meet this MLR requirement, the insurer is required to issue a rebate to employer groups. The rebates being issued by September 30, 2018 are based on premiums received in 2017. If the employer pays 100% of the premium, rebates are not shared with the individual subscribers. If employees pay a portion of the premium, they are entitled to a pro rata share of the rebate, although this can be in the form of a payment or a reduction in current premium contributions. Let us know if you have questions.
