On Monday, NC Insurance Commissioner Wayne Goodwin announced that almost $8.5 million in rebates is to be issued to approximately 162,000 health insurance policyholders in North Carolina as a result of the federal 80/20 rule.
The 80/20 Medical Loss Ratio Rule requires insurers in the individual and small group markets to spend at least 80 percent of premium dollars on health care and activities that improve the quality of health care, and no more than 20 percent on administrative costs. In the large group market, insurers must spend at least 85 percent of premiums on health care and quality improvements.
Insurance companies that fail to meet this standard owe policyholders a refund. Refunds are paid directly to consumers who purchase their own insurance as a check in the mail, a reimbursement or a direct reduction in future premiums. For consumers who bought insurance through their employer, the rebate is usually paid to the employer, who must provide the employee’s share as a check, reimbursement or reduction in future premiums, or apply it in some manner that benefits employees.
The following chart shows the three companies issuing the most in rebates in North Carolina by market for plan year 2014:
A full list of companies owing rebates by state can be found at www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/Issuers_Owing_Refunds_for_2014.pdf.
Detailed medical loss ratio information by company is available at www.cms.gov/apps/mlr/mlr-search.aspx.
