Medical Loss Ratio (MLR) Rebates: A Timely Reminder | Pennsylvania Benefits Partners

The Affordable Care Act (ACA) introduced the Medical Loss Ratio (MLR) to ensure that health insurance companies spend a significant portion of premiums on medical care and quality improvement activities rather than administrative costs and profits. When insurers fail to meet the MLR threshold, they are required to issue rebates to plan sponsors.

Understanding MLR Rebates

The MLR mandates that health insurers spend at least a certain percentage of premium dollars on medical claims and quality improvement activities. This percentage varies depending on the type of plan. If an insurer’s medical loss ratio falls below the required threshold, they must issue a rebate to the plan sponsor, typically the employer.

Approaching Deadlines: Time to Prepare

It’s essential for employers to be aware of the MLR rebate deadlines. These deadlines vary by year, but typically, insurers have until September 30th of the following year to issue rebates for the previous year’s plan performance. For instance, rebates for 2023 plan performance are due by September 30, 2024.

What to Do with Your MLR Rebate

Employers who receive MLR rebates should carefully consider how to use the funds. While the specific use of the funds depends on the plan’s legal structure and governing documents, some common options include:

Offsetting future premium costs: Using the rebate to reduce future premium payments.
Funding wellness programs: Investing in employee wellness initiatives to improve overall health and productivity.
Contributing to a health savings account (HSA): Offering additional contributions to employee HSAs to help cover healthcare costs.
Other plan improvements: Using the rebate to enhance other plan benefits or expand coverage options.

Important Considerations:

ERISA Compliance: If the rebate qualifies as a plan asset under ERISA, it must be used solely for the benefit of plan participants and beneficiaries.
Documentation: Maintain proper documentation of how the rebate is used to comply with regulatory requirements.

By understanding the MLR rebate process and carefully considering how to use the funds, employers can maximize the benefits of this unexpected windfall and improve the overall health and well-being of their workforce.