2019 Medical Loss Ratio Rebates

09/08/2020

The Affordable Care Act requires health insurers to spend at least 80% of the premiums they receive on health care services and improving quality of care. If a health insurance company spends less than 80% of premiums on these services, they must rebate their members the difference.

In 2019 Priority Health spent more than 80% on services and activities to improve quality of care. This means our commercial group and ACA individual members will not receive a rebate this year. The good news is that members can be assured their premiums in 2019 were spent on making health care more affordable and accessible. Federal law requires us to notify members only if we have not met the Medical Loss Ratio (MLR) target as defined by federal requirements under health care reform, thus no letter will be mailed. Download the 2019 MLR rebate letter.

Additional information from the federal government about Medical Loss Ratio:

  • The Affordable Care Act requires health insurers in the individual and small group markets to spend at least 80% of the premiums they receive on health care services and activities to improve health care quality. In the large group market, this amount is 85%. This is referred to as the Medical Loss Ratio rule, or the 80/20 rule. If a health insurer does not spend at least 80% of the premiums it receives on health care services and activities to improve health care quality, the insurer must rebate the difference.
  • 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 Sept. 30, 2019, health insurers must send any rebates due for 2019 and information to employers and individuals regarding any rebates due for 2019.

Please contact your sales representative with any questions about this information.