More than 47,000 Connecticut residents will get rebates from their health insurance companies this summer because the federal health reform law deems the premiums they paid too high.
The rebates will average $168 per family and will go to people who get their insurance through the state’s individual and small-group markets. Overall, Connecticut insurers will pay $5.6 million in rebates.
The payments are the result of a provision in the federal health reform law, the Affordable Care Act, that limits how much of insurance premium dollars can be spent on administrative expenses and other costs, including profits. The federal government refers to it as the “80/20 rule.”
Under the law, 80 percent of the money customers pay in premiums must be spent on medical care or quality improvement efforts, while the rest can go toward other costs. Companies that don’t meet the mark must pay the difference in rebates.
The 80 percent requirement covers health plans sold in the individual and small-group markets. Large-group plans must spend at least 85 percent of premium dollars on medical care or quality improvement.
The figures were released Thursday by the U.S. Department of Health and Human Services. The agency did not yet have available a list of which insurers will be issuing rebates. Overall, 8.5 million customers across the country will get rebates, averaging $100, according to the department.
The agency said more consumers benefit from the rule because it limits the proportion of premium dollars that can be spent on expenses not related to medical care, lowering the costs.
The majority of the Connecticut customers getting rebates — 25,979 — are those who bought coverage in the individual market. They’ll get an average of $64 back. Another 21,613 people who get their insurance through the small-group market will get rebates averaging $357.
This is the second year that insurers are required to provide rebates if they didn’t meet the mark under the health reform law. Last year, carriers were required to pay $12.9 million to 137,452 Connecticut customers. The average payment, $168, was the same as it is this year.
Aetna, ConnectiCare, Cigna, Golden Rule, U.S. Life and UnitedHealthcare were required to issue rebates last year. Anthem Blue Cross and Blue Shield and Oxford were not.
Last year, the bulk of the rebates — $8.5 million, to 85,179 customers — came from plans in the large-group market. This year, no plans in that market are issuing rebates.