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HHS: 11 insurers owe Pennsylvanians medical loss ratio refunds

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Eleven health insurers owe 90,485 Pennsylvanians refunds totaling $5,198,874 as a result of Obamacare's medical loss ratio rule, the U.S. Department of Health & Human Services announced today.

MLR, which the Obama administration has begun referring to as the 80/20 rule, requires insurers to spend at least 80 percent of premium dollars on patient care and quality improvement activities. For insurers selling large-group policies covering more than 50 employees, the requirement is 85 percent.

Insurers who operate in Pennsylvania and owe refunds for 2013 are as follows. The refunds average $75 per family, HHS said.

  • Aetna Life Insurance Company, individual market $825,437
  • Everence Insurance Company, small-group market $118,462
  • Freedom Life Insurance Company of America, individual market $46,476
  • Golden Rule Insurance Company, individual market $1,658,973
  • John Alden Life Insurance Company, small-group market $59,960
  • Mid-West National Life Insurance Company of Tennessee, individual market $139,432
  • Monumental Life Insurance Company, large-group market $263,316
  • National Foundation Life Insurance Company, individual market $50,672
  • The MEGA Life and Health Insurance Company, individual market $232,389
  • Time Insurance Company, individual market $1,537,970
  • Trustmark Life Insurance Company, large-group market $265,786

If their insurers did not meet the MLR requirement, Pennsylvanians will see their value reflected in one of the following ways:

  • a refund check in the mail;
  • a lump-sum reimbursement to the same account that they used to pay the premium if by credit card or debit card;
  • a reduction in their future premiums; or
  • their employer using refunds to improve their health coverage.

Nationwide, 6.8 million consumers will receive more than $330 million in refunds this year, with an average refund value of $80 per family. If insurance companies had maintained their 2011 ratios, HHS said, consumers would likely have paid an estimated $3.8 billion in additional premiums in 2013.

HHS also noted that the percent of consumers insured by companies that met or exceeded the MLR standard has risen each year since it went into effect in 2011. Refunds from these first three years total more than $1.9 billion nationwide.

Write to the Editorial Department at editorial@cpbj.com

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