ACA Overview – How Employers Should Handle MLR Rebates

The Affordable Care Act (ACA) established medical loss ratio (MLR) rules to help control health care coverage costs and ensure that enrollees receive value for their premium dollars. The MLR rules require health insurance issuers to spend 80-85 percent of premium dollars on medical care and health care quality improvement, rather than administrative costs.

Issuers that do not meet these requirements must provide rebates to consumers. Rebates must be provided by September 30 following the
end of the MLR reporting year. For the 2018 reporting year, issuers are required to pay rebates by
Sept. 30, 2019.

Employers that expect to receive rebates should review the MLR rebate rules and decide how they will administer the rebates. For assistance with rebates, please contact your Penniall & Associates, Inc. representative.

An issuer that does not meet its MLR standard…  

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