QUESTION

I got a letter saying my employer plan didn’t meet the medical loss ratio requirement (MLR). Will I get a rebate?

Post enrollment issues | Employer-Sponsored Coverage
ANSWER

Yes, your employer should get a rebate and it must be used for the “benefit of subscribers,” (covered employees) in the form of a cash check or discounted premiums. The Affordable Care Act requires health insurers, including those providing employer group plans, to meet a minimum medical loss ratio (MLR) standard. The MLR, also called the 80/20 rule, is a limit on how much premium revenue an insurer can devote to profits and administrative costs (20 percent in the individual and small employer markets and 15 percent in the large employer market) compared to what they spend on patient care. In the employer group market, if an insurance company does not meet this standard, they are required to return the difference to the policyholder (usually the employer) or directly to subscribers (employees) in the form of a rebate or reduction on future premiums. (45 C.F.R. § § 158.101 and 158.140).

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