Last week, The LA Times published an article about Blue Shield’s 2015 Medical Loss Ratio (MLR) rebates. The Affordable Care Act (ACA) requires health plans to spend a minimum percentage of premium revenue on medical expenses. This percentage is known as the Medical Loss Ratio (MLR).
Blue Shield’s report will show that we owe the following rebates to contract holders in plans regulated by the Department of Managed Health Care (DMHC):
- $61.7 million in MLR rebates to approximately 454,000 IFP subscribers (met 76.8% of 80% threshold)
- $21.1 million in MLR Rebates to approximately 19,000 small business contract holders (met 76.8% of 80% threshold)
As required by law, that amount will be paid by September 30, 2015 to IFP subscribers and Small Business contract holders (businesses, not individuals) in those plans with the rebates based on their premiums paid in 2014.
Blue Shield does not owe any rebates to Large Group contract holders in DMHC plans. No rebates will be owed by Blue Shield of California Life & Health Insurance Company (Blue Shield Life), which is regulated by the California Department of Insurance (CDI), for any IFP or group health insurance plans.
