QUESTION

My plan sent me a notice that they didn’t meet the medical loss ratio (MLR). Will I get rebate?

Post enrollment issues | Individual Health Insurance
ANSWER

Yes, you should get a rebate check or the equivalent value of a rebate. The Affordable Care Act requires health insurers 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 market) compared to what they spend on patient care. If an insurance company does not meet this standard, they are required to return the difference to the policyholder. If this happens with your health plan, you will receive a notice from your insurer, including the amount you are owed. Your insurance company can provide that rebate to you in the form of a reduced premium, a lump-sum check, or, if you paid by credit or debit card, by a lump-sum reimbursement to that account. (45 C.F.R. §§ 158.101, 158.140).

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Post enrollment issues