HHS Launches New Tool To Help You Find Out if You're Getting a Rebate From Your Health Insurer under the Affordable Care Act

HHS Launches New Tool to Find Amount of Health Insurance Premium Rebates due from Your Insurance Company by August 1, 2012 under Affordable Care ActThe U.S. Department of Health & Human Services (HHS) announced on Friday that it has launched a new online tool to help you find out whether your health insurance company is required to pay you a rebate on August 1, 2012, a new benefit under the Patient Protection & Affordable Care Act, President Obama’s signature Health Care Law.

If your insurer must pay rebates under the law, the new tool will tell you how much, on average, the insurer will be required to pay policyholders in your State.


“Under the health care law, nearly 13 million Americans are expected to benefit from $1.1 billion in rebates from insurance companies due by Aug. 1, 2012, because of the 80/20 rule,” HHS said in an announcement posted in its HealthCare Blog on Friday, July 13.

This is because the Patient Protection & Affordable Care Act, the new Health Care Law that some call “Obamacare,” holds health insurance companies accountable for how they spend your premium dollars. The law requires that insurance companies must spend at least 80% of each premium dollar on actual health care, rather than on administrative costs, executive salaries, or profits for the company. This 80/ 20 rule is called the “Medical Loss Ratio (MLR)” Rule under the law.

Insurers who fail to comply with this rule and fail to spend at least 80% of your premium dollars on actual medical care, are required by the Health Care Law to issue premium rebates to their policyholders by August 1, 2012.

“All insurance companies for the first time will send their policyholders a letter informing them of the rule and whether the insurer met the standard. Those that do not meet the 80/20 rule standard will inform consumers that they will receive a rebate.” The rebates are due to be paid by August 1, 2012.

The New Online Tool Launched by HHS

Find Out the Average Rebate Your Insurer Must Pay Policyholders in Your State. The new tool launched by HHS, located at HealthCare.gov, allows you to find out the average rebate your insurer is required to pay to policyholders in your State under the 80/ 20 rule (officially called the “Medical Loss Ratio (MLR) Rule) of the Affordable Care Act.

Here is a copy of the online form you can fill out. Just choose your State, enter your insurance company’s name, and select “MLR” (for Medical Loss Ratio information), and click Search:
New Online Tool from HHS to Help You Find Out Whether Your Insurance Company Must Pay You a Rebate under Patient Protection & Affordable Care Act

A page will then be displayed providing information about your insurance company’s compliance. At the bottom of the page, a table will tell you whether the company met the “MLR Standard” requirement to spend at least 80% of each premium dollar on actual health care, and if not, the average amount of premium rebates the company must pay to policyholders in the individual, small group, and large group markets in your state by August 1, 2012. Here is an example:
Sample Table from HHS Tool - Telling average rebate insurer must pay to policyholders in the state searched

Find Out If Your Insurer Has Proposed to Increase Premiums under Your Policy. The new tool also provides a form where you can find out if your insurance company has requested to raise premiums to policyholders in your State.

Under the Affordable Care Act, health insurance companies must, for the first time, tell consumers when they want to increase insurance rates for individual or small group policies by an average of 10% or more, and must undergo a review process where they must justify any such rate increases. More information about the Rate Reviews required under the Affordable Care Act is available from HealthCare.gov.

As a consequence of the Rate Reviews required by the Affordable Care Act, it is not unusual to find via this tool that your insurance company may have requested a premium increase for your State, but after the Rate Review process, withdrew the requested increase.

This is another way in which the Affordable Care Act is making health care more affordable for consumers. See, HHS Notes Successes of Affordable Care Act (Obamacare) on its 2-Year Anniversary

How You Will Receive Your Rebate

According to the information provided via the new tool on HealthCare.gov, insurers that owe rebates must pay—and provide a notice to consumers—by August 1, 2012.

“Consumers may see the “rebate” in a number of ways,” HHS states. “These include:

  • A rebate check in the mail;
  • A lump-sum reimbursement to the same account that was used to pay the premium if it was paid by credit card or debit card;
  • A direct reduction in their future premiums; or
  • Your employer using one of the above rebate methods, or applying the rebate in a manner that benefits employees.”

“People who have individual insurance policies will receive the rebate directly from the insurer,” HHS states. “In the small group and large group markets, the rebate is usually paid to the employer, which may use one of the above rebate methods, or apply the rebate in a manner that benefits employees,” HHS explains.

More Information

Visit HealthCare.gov to find out more about the $1.1 Billlion in rebates that almost 13 million consumers will be receiving from their insurance companies under the Medical Loss Ratio (MLR) rule (also called the 80/20 rule) of the Affordable Care Act, including:

See related HelpingYouCare™ reports on:

15.8 Million Americans to Receive $1.3 Billion in Rebates from Insurers Due to Affordable Care Act, HHS Announces

Government Imposes Review on All Premium Rate Hikes of 10% or More by Health Insurers

HHS Notes Successes of Affordable Care Act (Obamacare) on its 2-Year Anniversary

President Obama Lays Out Contents of Health Care Law

For more news and information on the Patient Protection & Affordable Care Act and health care reform, see also the HelpingYouCare™ resource pages on VoicesForCare™, including:


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