SALT LAKE CITY - Regence BlueCross BlueShield of Utahfiled its medical loss ratio (MLR) for the Large Group, Small Group and Individual pools with U.S. Health and Human Services June 1.
Medical Loss Ratio refers to the portion of premium that is spent on the full range of medical care: Doctor visits, tests and scans, medication, devices and equipment, hospital stays and other covered services.
The Affordable Care Act calls for insurers to meet an MLR threshold of 80 percent of premium toward claims and certain allowable quality activities for Individual and Small Group pools (85 percent for large groups), or rebate premium to policyholders.
Regence exceeded the MLR thresholds for its Large Group pool and Individual pool. However, it will issue a rebate for its Small Group members. The Utah Small Group pool MLR was 78.2 percent, as demand for medical services came in slightly lower than projected. Regence will return an average of $166 per covered employee.
Regence carefully calculates expected claims costs for each pool with a goal of setting premium that just covers claims and cost of administering plans, in keeping with our nonprofit values. Natural fluctuations in demand can result in fewer claims than projected. When this occurs, and MLR is below the federal threshold, a rebate is paid to policyholders as required by ACA.
Checks are scheduled to be mailed to the policyholder, such as an employer group, in mid-July, to comply with the Aug. 1 deadline. Members of these groups will be notified of the rebate as well, in accordance with federal regulations.  Both mailings will include an explanation of the rebate.
About Regence BlueCross BlueShield of Utah
Regence BlueCross BlueShield of Utah is a leading health plan in Utah, with more than 330,000 members, offering health, life and dental insurance. Regence BlueCross BlueShield of Utah is a nonprofit independent licensee of the Blue Cross and Blue Shield Association, and is affiliated with Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon and Regence BlueShield (selected counties in Washington). Together, the companies serve more than two million members in the Northwest/Intermountain Region. The Regence affiliated companies are committed to improving the health of its members and communities, and to transforming the health care system. For more information, please visit