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BCBSTX Provides Information on Affordable Care Act Medical Loss Ratio

Jul. 11, 2012

The MLR standard of the Affordable Care Act requires health insurance companies to devote 80% or 85% of the premiums they collect to provide health care services to customers, after subtracting taxes and regulatory fees. If an insurer does not meet the MLR standards, it may pay rebates to its customers. Given the inherently unpredictable nature of health care costs and utilization, it is not surprising that health plans may pay rebates to some customers in certain markets.

On June 1, Health Care Service Corporation (HCSC) provided the required Medical Loss Ratio (MLR) report to the U.S. Department of Health and Human Services (HHS) containing MLR/Rebate information for all four of its Blue Cross and Blue Shield Plans. HCSC met or exceeded the medical loss ratio standards for the vast majority of customers in 2011 and anticipates that only 4 percent of the total customer base will receive a rebate.

As a result of, among other things, strong expense management, collaboration with providers, and business innovations, Blue Cross and Blue Shield of Texas (BCBSTX), a division of HCSC, met or exceeded the MLR standards for the vast majority of our customers in 2011. Last year, BCBSTX’s average medical loss ratio across all lines of business was 85.9 percent.

Part of the information filed in June reported that approximately 8 percent of our total customers in Texas will be paid a rebate and will receive notification this month as to the exact amount. For those Texas Individual Market customers that will receive rebates, we anticipate the one-time rebate for 2011 may range anywhere from $5 to possibly a few hundred dollars this year. Given the inherently unpredictable nature of health care costs and utilization, it is not surprising that health plans may pay rebates to some customers in certain markets.

BCBSTX is part of a customer-owned organization that reinvests its earnings to benefit the health and wellness of its customers. We are proud of our track record of strong expense management, collaboration with providers and other health care professionals, and business innovations.

Notice to Policyholders and Subscribers when MLR Standard is Met (MLR Notice #4)

The Affordable Care Act requires health insurance issuers to provide a notice to subscribers and policyholders in the individual market, small group market and large group market who are not receiving an MLR rebate.

View the specific notice that will be provided to members that are not receiving a rebate now .

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