Where’s My Health Insurance Premium Rebate?


In August some people received a rebate check from their health insurance carrier, but many more did not.  To some this has led to considerable consternation to many – especially in light of the Department of Health and Human Services’ (HHS’s) public claim that Americans receiving the rebate will benefit from an average rebate of $151 per household.  The explanation as to why some but not others will receive a rebate is found in the details of the Affordable Care Act.
 
Under the federal Affordable Care Act health insurers issuing individual and small group plans must spend 80% of the premiums paid by consumers on health care and activities to improve health care quality.  The percentage of premium income an insurer spends on care and improving quality is called “Medical Loss Ratio” or MLR.  The health insurers MLR is determined separately for each state’s individual, small group and large group markets.  The only health insurers that are required to pay a rebate are those who do not meet the 80% target.

So let’s suppose you were an insured under California Anthem Blue Cross individual plan in 2012.   Based on the report submitted by Blue Cross to HHS they paid 80.9% of your premium on care or improving the quality of healthcare.  Consequently, you would not receive a rebate.  But don’t feel too bad: many California insured persons did not. 

About the Author:  Margy Wenham has been working as an independent insurance agent for over twenty (20) years in Redding, California.  She represents most major insurance carriers and can be contact at 530.221.0955 or through her website www.InsuredByMargy.com. 

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