The Affordable Care Act's medical loss ratio (MLR) rules require group health insurance issuers to provide rebates if their MLR-the percentage of health insurance premiums spent on health care and activities to improve health care quality-falls short of the applicable standard during a reporting year. Each year's rebates must be issued to plan sponsors by September 30 of the following year. As a result, plan sponsors should be looking for these rebates to arrive in the coming weeks.

Employer Distribution

The MLR rules provide that issuers must pay any rebates owed to persons covered under a group health plan to the policyholder, who is then responsible for distributing the rebate to the eligible plan enrollees. In general, there are several ways rebates may be distributed by plan sponsors to plan enrollees, including:

  • A rebates 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; or
  • A direct reduction in future premiums.

In addition to the above methods, employers may also apply the rebate in a way that benefits employees. However, decisions on how to apply or expend the plan's portion of a rebate are subject to the general standards of fiduciary conduct under the federal Employee Retirement Income Security Act (ERISA).

Welcome Amanda to the Team!
We are also pleased to welcome Amanda to IA, a MMA LLC Company. Amanda began her career in the industry fifteen years ago at a boutique insurance firm in Bethesda, MD as a Relationship Manager primarily working on large premium finance cases and then as a wholesaler for fixed indexed annuities. From there her experience in healthcare blossomed as she became a producer for Kelly Insurance Agency in Leesburg, VA. In her first year she sold eleven groups in the mid-to-large market space and became the number one producer in new production in her second year. In the three and a half years she was at Kelly Insurance Agency, she built a substantial book of business with groups in NOVA and Maryland. Her most recent experience includes working for a major carrier selling direct to businesses but quickly realized she missed consulting with clients and maintaining strong client relationships. 
 
Amanda grew up in Damascus, MD and played ASA Junior Olympic fastpitch softball which landed her a full ride at the University of Findlay in Findlay, Ohio. She received a degree in social work and public administration. She's lived in southern CA and northern CA before relocating to the east coast in 2006. Amanda currently resides in Brunswick, MD along the Potomac River with her two sons Eoin (pronounced Owen) age 15 & Finn age 13. She loves the C&O Canal for biking, hiking, kayaking, or adventuring.

We are proud to welcome Amanda to our Employee Benefits team and know she will be a great asset to our clients!

IA a MMA Company | 301.838.9400 | office@insassoc.com | insassoc.com