The Affordable Care Act requires Blue Shield of California to refund part of the premiums it receives if it does not spend at least 80% of the premiums on healthcare services, such as doctors and hospital bills, and activities to improve healthcare quality, such as efforts to improve patient safety. This is referred to as the Medical Loss Ratio (MLR) requirement.
The Affordable Care Act requires that health carriers spend at least:
Subscribers and employer groups who are eligible for 2019 rebates are listed below and will be notified by letter by September 30, 2020.
Blue Shield of California Small Business Plans (DMHC regulated)
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.
If you have any questions, please call Producer Services at (800) 559-5905 or contact your Blue Shield representative.
Medical Loss Ratio FAQs (PDF, 68KB)
Blue Shield of California is mailing IFP Subscribers (OnEx, OffEx) letters and endorsements explaining recent changes based on the following California laws and regulations.
Please see the endorsement letters for additional information.
Blue Shield of California is mailing Small Business and Core Group Administrators letters and endorsements explaining recent changes based on the following California laws and regulations.
Please see the attached letters for additional information.
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Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Health plans are offered by Blue Shield of California.