Sep 11, 2023
The Affordable Care Act (ACA) requires Blue Shield of California and other health insurance carriers to spend a minimum percentage of plan members’ premium on medical expenses, known as the “Medical Loss Ratio” standard or the “80/20 rule.” The 80/20 rule in the Affordable Care Act is intended to ensure that consumers get value for their healthcare dollars.
The Medical Loss Ratio reporting and rebate requirements apply to all fully insured group and individual commercial plans, including grandfathered plans. They do not apply to self-funded (ASO) business, Shared Advantage, or Medicare Supplemental plans.
2022 MLR
Blue Shield of California (Blue Shield) does not owe Medical Loss Ratio rebates for 2022 to the following fully-insured subscribers and employer groups 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.
- Small Business groups with Blue Shield plans.
- Large groups with Blue Shield and Blue Shield Life plans.
See MLR results from all of Amwins partners.
