The Affordable Care Act (ACA) requires health insurers (including grandfathered but not self-funded plans) to report the percentage of their premium revenue that the insurer spends on clinical services for enrollees, activities that improve healthcare quality and all other non-claims costs, excluding federal and state taxes and licensing or regulatory fees to HHS each year. The insurers in the individual and small group markets must spend at least 80% and insurers in the large group market at least 85% of the premium revenues on these costs.

This is referred to as the Medical Loss Ratio (MLR) rule or the 80/20 rule. If a health insurer does not spend at least 80% of the premiums it receives on healthcare services and activities to improve healthcare quality, the insurer must rebate the difference to members.

A health insurer's MLR is determined separately for each state's individual, small group and large group markets in which the health insurer offers health insurance. In some states, health insurers must meet a higher or lower MLR.

No later than August 1, 2012, health insurers must send any rebates due for 2011 and information to employers and individuals regarding any rebates due for 2011.

Attached is a link to a list of the insurance carriers in each of the 50 States that must provide rebates.  http://cciio.cms.gov/resources/files/mlr-issuer-rebates1.pdf

For 2011, no one in Ohio who's covered by a large group plan - a company with 51 or more employees - is due a rebate, according to Health and Human Services.  There were three small group carriers in Ohio that are required to provide rebates. The average rebate in Ohio's small group market is estimated to be $40.22, according to a Kaiser Family Foundation analysis.

Companies (employers) receiving the rebates must provide them to employees in a timely manner, but they can distribute them as checks to employees, a deduction from next year's premium or as an additional health benefit, according to Health and Human Services.

Thank you,

The Alpha Group