The first Medical Loss Ratio rebate checks were mailed to small groups insured by Regence BlueShield of Idaho on July 16th. This is a rebate on their 2011 premium under the Affordable Care Act’s requirement based on medical loss ratio (MLR).
A total of $980,000 was distributed. Rebates vary according to the size of the each group. The checks are small, less than one percent of the premium paid by the small group in 2011. This is because Regence’s small group MLR was 79.1 percent, nearly meeting the required 80 percent for this risk pool.
The rebate is calculated based upon “adjusted premium”, which reflects the reduction required by U.S. Department of Health and Human Services (HHS) for expenses such as income tax, premium tax, employment tax, state assessments, etc.
In their news release Regence said, “We met the MLR threshold for individual and large group pools in Idaho, and in all pools in the other three Regence states where we operate health plans. As a nonprofit insurer, it is our goal to price premiums to cover expected claims and administrative costs as close to break-even as possible. This is how we operated before the Affordable Care Act, and how we will continue to operate in the future.”
Source: Regence BlueShield of Idaho, News Release - July 17, 2012