BOISE - Regence BlueShield of Idaho filed 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 the Large Group pool and Individual pools. However, it will issue a rebate for its Small Group members. The Idaho Small Group pool MLR was 77.9 percent, as demand for medical services came in slightly lower than projected. Regence will return an average of $142 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 BlueShield of Idaho
Regence BlueShield of Idaho is a leading health plan in Idaho with about 160,000 members, offering health, life and dental insurance. Regence BlueShield of Idaho is a nonprofit mutual insurance company and an independent licensee of the Blue Cross and Blue Shield Association. Regence BlueShield of Idaho is affiliated with Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah 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 www.regence.com or www.twitter.com/RegenceIdaho.