Keep a look out for a cheque from your insurer if you purchase health insurance on the public exchange.
Beginning this month, insurance companies will give rebates totaling $1 billion to 8.2 million customers. According to an estimate from the Kaiser Family Foundation, of those, the bulk ($603 million) will go to consumers who have a health plan through either the federal health exchange or their state’s marketplace (if it has one).
The typical rebate for participants in the marketplace is $141.
Even while not everyone who obtains coverage in that manner will be eligible for a reimbursement, it is important to pay attention to correspondence from your insurance provider (or your insurer in 2021, if different).
According to Cynthia Cox, vice president at the Kaiser Family Foundation and director of its Affordable Care Act program, those rebates, which may occur annually depending on the insurance, frequently arrive in the mail. She added that other checks in previous years had been unclaimed.
“There are some people who are missing out,” Cox said.
A total of $76.9 million in refunds across marketplace plans, small group, and large group policies went unclaimed from 2012, the first year that rebates were distributed, through 2018, according to Kaiser research. The regulations governing unclaimed property in each state generally apply to unclaimed rebates.
“If you’ve moved, you may want to contact your insurer to see if you’re due a rebate,” she said. “Insurers are supposed to make a good faith effort to locate you, but … some rebates go unclaimed.”
Some participants in corporate plans may also receive a rebate
In addition to the $603 million going to marketplace enrollees, the foundation estimates that an additional $275 million will go to enrollees in small employer plans and $168 million will go to enrollees in big group plans (excluding those at organizations that self-insure). Not everyone who enrolls in insurance this manner will be eligible for a refund, just like with marketplace enrollees.
In a small-group plan, the average rebate per qualifying member comes to $155 while in large-group plans, it comes to $79. The rebate amount can, however, differ significantly based on your region and insurer.
Some insurers offer you a cheque, while others provide you a credit toward future premium payments. Be aware that your employer might divide the rebate with you if you participate in a group plan, according to Cox. Simply put, this is because the cost of insurance premiums is often shared by you and your employer.
Medical loss ratios are met by sending rebates from health insurance
Why are the rebates being issued then?
Basically, “medical loss ratio” regulations force insurance providers who offer group or individual policies to spend at least 80% of enrollee premiums on medical bills and other costs associated with patient health. (The ratio is 85/15 for large group insurance plans). If that criterion is not met, enrollees are paid the difference.
The ratio is computed annually using a rolling average over the previous three years. As a result, the insurance companies’ financial data from 2019 through 2021 served as the basis for this year’s rebates, which will be distributed to organizations and people who joined the plan in 2021.
Refunds issued overall totaled $1 billion, down from $2 billion in 2021 and a record $2.5 billion in 2020.
