Health Plans To Refund $1.3 Billion In Premium Overcharges

Health insurers could be required to refund up to $1.3 billion to consumers and employers this summer under the medical loss ratio (MLR) provision of the Patient Protection and Affordable Care Act of 2010 (PPACA). The MLR provision requires individual and small group health plans to spend 80% of premiums paid on enrollees’ direct health care expenses. Large plans must spend 85% of premiums on enrollees’ direct health care expenses. Unless the state has received a federal waiver to establish a lower medical loss ratio, plans that spend less must refund a percentage of premiums back to the plan . . .