The Patient Protection and Affordable Care Act requires insurers to meet specific medical loss ratio goals. Under the Affordable Care Act, the federal medical loss ratio requirements are 85 percent for large groups, which means that at least 85 percent of every premium dollar goes toward medical expenses, and 80 percent for small groups and individuals. In Massachusetts, the requirement for small groups and individuals (or merged market) is even higher — it is 90 percent.
Under Massachusetts law, if an insurer's medical loss ratio is below the requirement, the company must issue rebates to the companies and people they insure. Blue Cross Blue Shield of Massachusetts will not be issuing rebates, as our loss ratio exceeded both state and federal medical loss ratio standards for all market segments subject to medical loss ratio regulations. Our ability to surpass the state and national standards reflects our commitment to offering the best possible value to our customers and to keeping our administrative costs as low as possible.
Learn more about medical loss ratio at www.HealthCare.gov or www.mass.gov.