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Medical Loss Ratio Rebate Information

National health reform law (Affordable Care Act or ACA) and Massachusetts law require health insurers to spend a minimum percentage of premium dollars on medical expenses, referred to as medical loss ratio or MLR. If a minimum MLR is not met in a particular market segment, the insurer is required to provide a premium rebate to the customers in that market segment.

The minimum MLR thresholds under the federal law are 85% for large group business and 80% for small group and individual business. Massachusetts has a separate minimum MLR rebate threshold, 90%, for the MA merged market (small groups under 51 benefit eligible employees and most non-group plans).

Insurers were required to report their MA Merged Market MLR calculations with the Massachusetts Division of Insurance on May 31, 2013, and their federal MLR calculations with Health and Human Services (HHS) on June 1, 2013. Applicable MA Merged Market rebates need to be issued by June 30, 2013 and federal rebates by August 1, 2013.

Neighborhood Health Plan will issue rebates for 2012

Neighborhood Health Plan will be issuing 2012 premium rebates to the Massachusetts merged market at the end of June and to large group employers under the federal Affordable Care Act at the end of July.

FAQS about Merged Market Medical Loss Ratio

FAQS about Large Group Medical Loss Ratio