Which carriers paid the most MLR rebates?News added by Benefits Pro on August 5, 2014

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By Kathryn Mayer

Blue Cross & Blue Shield of Florida Inc. paid the largest refund to policyholders and enrollees under the medical loss ratio provision in the Patient Protection and Affordable Care Act in 2013, according to the latest data.

The carrier had $10.1 million of refunds due in its home state as of June 30, according to data available from the Centers for Medicare and Medicaid Services and analyzed by SNL Insurance.

Under the MLR provision, carriers must issue refunds to customers if they spend less than 80 percent of the premiums they collect for plans sold on the individual and small group markets and less than 85 percent of plan premiums in the large group market on health care.

Blue Cross & Blue Shield of Florida recorded a medical loss ratio of 78.6 percent on small-group business in 2013, according to SNL data. (The refunds were all due on small group business, as opposed to individual and large-group business.)

This was down slightly from 79.3 percent in 2012, but up from 76.2 percent in 2011.

After Blue Cross & Blue Shield of Florida, the other largest state refunds owed by individual insurers in 2013 were:
  • Health Options Inc. (Florida), 9.1 million
  • Blue Cross and Blue Shield of South Carolina, 6.5 million
  • Aetna Health Inc. (DC), 6.4 million
  • Anthem Insurance Cos. Inc. (Indiana), 6.2 million
  • Neighborhood Health Plan Inc. (Massachusetts), 6.1 million
  • UnitedHealthcare Insurance Co. (Oklahoma), 5.5 million
  • Time Insurance Co. (Texas), 4.5 million
  • Anthem Health Plans of Kentucky, 4.4 million
  • UnitedHealthCare Insurnace Co. (North Carolina), 4.4 million
Additionally, analysis found that, on an aggregate basis, Florida and Maryland had the two highest statewide levels of refunds, and Vermont had the lowest.

But, analysis said, “in relation to the amount of health premiums earned reported by insurers within the state, these were not the largest. Excluding California, the largest ratio of refunds to health premiums earned could be found in Montana, according to SNL and CMS data. This analysis excludes California because most companies in that state do not file with the NAIC, and therefore the data is not comparable.”

The U.S. Department of Health and Human Services last month said carriers will send out about $330 million in rebates to employers and individuals this summer under the MLR rule. Since 2011, carriers have returned about $9 billion to consumers because of the PPACA provision.

Originally published on BenefitsPro.com
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