Rules from the Department of Labor (DOL) that kicked in Jan. 1 mandate that health insurers rebate to plan participants any money left over if they fail to achieve the goal of spending 80 to 85 percent of every premium dollar on medical care or health care quality improvement. The first payments would commence Aug. 1, 2012.
The spending goal is part of the reforms initiated under the Patient Protection and Affordable Care Act (PPACA) of 2010, and the implementing rules for the concomitant rebates were released this past December to take effect at the start of 2012.
However, the rebates (if they are triggered) don't necessarily go directly to the employee-participants. In some cases, the employer administering the plan can choose to use the rebates for premium reductions or for added health care benefits. Any money that employees do receive as a rebate will be non-taxable.