The Affordable Care Act sets strict limits on how much of every premium dollar health insurers must spend on claims versus administrative expenses and profits. These Medical Loss Ratio (MLR) limits for small groups are 80%; for larger groups, 85%.
Headlines this week pronounced refunds are imminent so I made a few phone calls.
Most insurers in Wisconsin have been managing to those target loss ratios prior to passage of health reform. Although the final accounting for 2011 is a work in progress, I could not find a group insurer planning for refunds. And self‐insured plans are exempt from this requirement.
So, if you’re planning on a refund check, at best, it will be very, very small.