MLR

2018 MIDTERM ELECTION

Time: D H M S

via Christopher Snowbeck of the Star-Tribune:

Positive Blue Cross results trigger rebates to consumers
It is legally required to return about $30 million of its 2017 profit to subscribers.

After three years of losses in the state’s market where individuals buy health insurance, Blue Cross and Blue Shield of Minnesota made so much money last year that it has to give some back.

The Eagan-based carrier, which is the state’s largest nonprofit health plan, disclosed last week that it expects to provide $30 million in consumer rebates as required by rules in the federal Affordable Care Act (ACA).

Analysts said that Blue Cross likely isn’t alone in having overshot with rates last year, since insurers across the country have been struggling to figure out how much premium revenue they need to cover the cost of medical bills in the individual market.

In Minnesota, rebates driven by big margins are a surprising cap to a year that started with fears that mounting losses would cause a market collapse.

One of the least-known but most important aspects of the Affordable Care Act is the Medical Loss Ratio:

The Affordable Care Act (ACA) includes several provisions that change the way private health insurance is regulated in an effort to provide better value to consumers and increase transparency. One such provision – the Medical Loss Ratio (or MLR) requirement – limits the portion of premium dollars health insurers may spend on administration, marketing, and profits. Under health care reform, health insurers must publicly report the portion of premium dollars spent on health care and quality improvement and other activities in each state they operate. Insurers failing to meet the applicable MLR standard must pay rebates to consumers beginning in 2012.