Capital BlueCross: Medical Loss Ratio

The Affordable Care Act requires health insurers to issue a rebate if a federally set Medical Loss Ratio (MLR) standard is not met. Specifically, the ACA mandates that 80 percent of premium dollars for individual and small group products and 85 percent of premium dollars for large group products must be spent on health care and quality improvement activities. If that standard is not met, a rebate for the difference must be issued to the contract holder. While Capital BlueCross strives to provide the best quality care at the lowest cost to all of our members, the MLR for some contracts (only individuals covered through CAAC) fell below the standard in 2014.

Communication to impacted members were issued starting mid-September


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The information provided is for informational purposes only and does not constitute legal advice. The information above contains only a summary of the applicable legal provisions and does not purport to cover every aspect of any particular law, regulation or requirement. Depending on the specific facts of any situation, there may be additional or different requirements. This is to be used only as a guide and not as a definitive description of your compliance obligations.