Medical Loss Ratio

[ABC]

I just heard that the MLR for health care reform will be decided on a case by case basis. Now here the big kicker.

If a group has a good year and they are eligible for reimbursementthe group does not get the refund but the insured does.

Can anyone confirm this?

If this is true then this is a major redistribution of wealth.

 

[CHUMPS FROM OXFORD]

"Effective January 1, 2011, health insurers will be required to spend at least 80 cents out of every premium dollar in the individual and small group markets, and at least 85 cents in the large group market -- or refund the difference to consumers in the form of rebates."

 

[stuy119]

This is going to be fun to watch. LOL
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So this just hit me.

If it's on a case-by-case basis, then one employer could have claims of 3x what they pay in on an annual premium basis, and the insurer has to suck it up and deal with it. If another company has zero claims (never will happen) and pays out nothing, then they have to refund 85% to the consumer?

Yeah, that's going to work.

And, if that happens, is the insurance carrier required to issue 1099's to all members who receive a refund?

That will go over well.

 

[somarco]

This is just one of the reasons why Obamacare will implode. I don't see any carrier willing to play under those rules, and if the employers throw in the towel on group health insurance . . . game over.