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 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 2018
Members and employer groups who are eligible for MLR rebates for 2018 will be notified by letter by September 30, 2019.
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, 2019. Blue Shield missed the 80 percent target by 0.3% of premiums for its Small Business Plans in 2018.
Frequently Asked Questions About MLR
MLR Talking Points and FAQs (PDF, 66 KB) - updated August 22, 2019