The Department of Health and Human Services (HHS) has released a final rule on health insurers' compliance with the medical-loss ratio (MLR) standards of the Patient Protection and Affordable Care Act (PPACA) that will result in all insured Americans receiving a letter from their insurance company this summer, even if they're not receiving a rebate.
Under PPACA, health insurance companies must spend 80 percent of premiums received in the individual market on direct medical costs and 85 percent in the group market. If they fail to reach their applicable medical-loss ratio (that is, if they spend less than 80 or 85 percent on medical costs), they must issue rebates to the consumers or group plans on or after July 1, 2012, but no later than Aug. 1, 2012.
Under the final rule released this past Friday, even companies that meet their medical-loss ratios must issue letters explaining what the MLR is and why there is no rebate coming. The HHS final rule calls this "a notice of MLR information." The notice must employ standardized language from the HHS final rule and must direct the recipients to visit www.HealthCare.gov for further information on MLR.