by Janet Lavelle / U-T San Diego / June 21, 2012
Nearly 12.8 million Americans, including 1.9 million Californians, are expected to benefit from rebates on their health insurance this summer as part of the federal Affordable Care Act, officials announced Thursday.
Starting this year, the federal health care law requires insurers to spend at least 80 percent of premium costs on medical care and improvement or refund the difference to consumers by Aug. 1 of each year.
In California, the average refund is expected to be $65, compared to $151 on average nationwide. Average rebates on small group insurance policies are $206, large group insurance rebates average $43 and individual policy rebates average $30 in California, according to federal officials.
Consumers may receive a refund through a rebate check or credit card reimbursement, or as a reduction in future premiums. For people who get insurance through their job, the refund would go to the employer who could apply it to benefit employees.
“The 80/20 rule helps ensure consumers get fair value for their health care dollar,” said U.S. Health and Human Services Secretary Kathleen Sebelius in making the announcement.
The federal regulation, called the medical loss ratio standard, requires 80 percent of premiums on individual and small group policies to go for medical care or quality improvements and 85 percent in large group policies.
While the Supreme Court is expected to rule on the fate of the federal health care law next week and if it strikes down the entire law the rebate could go with it. That would probably not affect Californians, though, because California enacted an identical law in 2011.
State insurance Commissioner Dave Jones noted that the medical loss ratio is one of several elements of the Affordable Care Act that have been made into state law.
“In fact the night of my swearing in (in January 2011) I signed my first regulation implementing the provisions of the Affordable Care Act,” Jones said in an interview earlier this week. “The medical loss ratio law requires health insurers to put a larger percentage of the premiums they collect on paying doctors, nurses, hospitals and other providers for the medical care we get.”