Properly Handling Medical Loss Ratio (MLR) Rebates
Quick Facts The Affordable Care Act (ACA) requires health insurers to spend a minimum percentage of premiums on medical care, called the medical loss ratio (MLR). The minimum federal MLR standards are 80% for small group policies or 85% in the large group market. Insurers, including HMOs, must rebate (refund) any excess premiums to the policyholder by September 30 of the following year. Employers that receive MLR rebates must handle the funds in accordance with applicable plan terms and federal guidance. Background The Affordable Care Act (ACA) requires health insurers and HMOs to spend at least a certain percentage of …
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