These basics will help you understand the Medical Loss Ratio (MLR) provision of federal health reform and what Blue Shield is doing to put it into action.

What is the Medical Loss Ratio (MLR)?

The Medical Loss Ratio (MLR) standard requires health plans, like Blue Shield of California (Blue Shield), to spend at least 80 percent of premiums for Individuals and Family Plans and small group business, and 85 percent for group plans sponsored by companies with more than 100 employees, on medical expenses to help ensure that consumers get value for their healthcare dollars. If carriers do not meet the MLR standard, they are required to pay rebates to eligible employers and subscribers.


MLR rebates for 2019

Members and employer groups who are eligible for MLR rebates for 2019 will be notified by letter by September 30, 2020. 

Small business plans

Eligible employers enrolled in health plans from Blue Shield of California (Blue Shield), with 100 or fewer employees, will receive rebates by September 30, 2020. Blue Shield missed the 80 percent target by 1.0% of premiums for its Small Business Plans in 2019.

The following subscribers and employer groups will not receive 2019 rebates, since Blue Shield met or exceeded the MLR targets for those health plans. 
Individual and Family subscribers with Blue Shield and Blue Shield of California Life & Health Insurance Company (Blue Shield Life) plans
Large groups with Blue Shield and Blue Shield Life plans
 
If you did not receive a rebate, Blue Shield met or exceeded the medical loss ratio (MLR) requirements for your health plan. That means we spent at least the required 80 to 85 percent of your premium dollars on health care.
 

Learn more about MLR 


Frequently Asked Questions About MLR

MLR Talking Points and FAQs (PDF, 68 KB) - updated Sep 15, 2020