The Department of Health and Human Services has released a notice saying consumers can now expect to get the most out of their health insurance dollar, according to an HHS news release.
The Patient Protection and Affordable Care Act requires that health insurers spend at least 80 to 85 percent of total premium dollars (depending on the insurer's market) on medical care and quality improvement — the medical loss ratio — and any insurer that does not meet the MLR must pay rebates to its customers.
HHS estimates that consumers will receive up to $323 million this year in rebates from health insurers based on what would have been owed if all state rate adjustment requests were granted, according to the release. HHS also proposed that insurers send out MLR notices to consumers even if they did meet the MLR requirement.
HHS also finished its review of states that requested a waiver from the MLR, according to a report from The Hill. Yesterday, HHS denied Wisconsin's request for a gradual adjustment into the MLR and partially approved North Carolina's request.
Wisconsin proposed a MLR of 71 percent in 2011, 74 percent in 2012 and 77 percent in 2013, which was turned down. North Carolina's proposal was partially approved, as HHS determined small insurers would struggle with the MLR because the state's health insurance market was too heavily concentrated — Blue Cross Blue Shield has 81 percent of the market. HHS granted an alternative adjustment to North Carolina insurers, as the MLR will be 75 percent in 2011 but will then be 80 percent in 2012 and beyond, according to the report.
In total, HHS denied MLR waiver adjustments for 10 states (Delaware, Florida, Indiana, Kansas, Louisiana, Michigan, North Dakota, Oklahoma, Texas and Wisconsin) and partially approved MLR proposals for seven states (Georgia, Iowa, Kentucky, Maine, Nevada, New Hampshire and North Carolina).
The Patient Protection and Affordable Care Act requires that health insurers spend at least 80 to 85 percent of total premium dollars (depending on the insurer's market) on medical care and quality improvement — the medical loss ratio — and any insurer that does not meet the MLR must pay rebates to its customers.
HHS estimates that consumers will receive up to $323 million this year in rebates from health insurers based on what would have been owed if all state rate adjustment requests were granted, according to the release. HHS also proposed that insurers send out MLR notices to consumers even if they did meet the MLR requirement.
HHS also finished its review of states that requested a waiver from the MLR, according to a report from The Hill. Yesterday, HHS denied Wisconsin's request for a gradual adjustment into the MLR and partially approved North Carolina's request.
Wisconsin proposed a MLR of 71 percent in 2011, 74 percent in 2012 and 77 percent in 2013, which was turned down. North Carolina's proposal was partially approved, as HHS determined small insurers would struggle with the MLR because the state's health insurance market was too heavily concentrated — Blue Cross Blue Shield has 81 percent of the market. HHS granted an alternative adjustment to North Carolina insurers, as the MLR will be 75 percent in 2011 but will then be 80 percent in 2012 and beyond, according to the report.
In total, HHS denied MLR waiver adjustments for 10 states (Delaware, Florida, Indiana, Kansas, Louisiana, Michigan, North Dakota, Oklahoma, Texas and Wisconsin) and partially approved MLR proposals for seven states (Georgia, Iowa, Kentucky, Maine, Nevada, New Hampshire and North Carolina).
Related Articles on the Medical Loss Ratio:
Healthcare Reform: Two Years Gone, Now What's on the Horizon?
HHS Rejects Texas' Request for Medical Loss Ratio Waiver
HHS Denies Medical Loss Ratio Adjustments for Kansas, Oklahoma