Centers for Medicare and Medicaid Services: Health Insurers to Pay 12.8 Million Members $1.1 Billion in Rebates under Medical Loss Ratio Regulation

The Centers for Medicare and Medicaid Services (CMS) has listed the dozens of health insurance companies that failed to meet the minimum “medical loss ratio” required by section 1001 of the Patient Protection and Affordable Care Act.  The medical loss ratio requires at least 80% of health insurance premiums collected by health insurance companies in the individual and small group markets to be spent on medical care (rather than spent on administrative expenses or retained as profits).  If an insurance company exceeds the medical loss ratio, it must refund or provide a rebate of the amount of premiums collected above the ratio.  The medical loss ratio is 85% for  health insurance premiums collected in the large group health insurance market.  According to the CMS, over 12.8 million insured Americans will receive over $1.1 billion in premium rebates beginning in August 2012.

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