BCBS rebates $25M funds to Tennesseans under individual health coverage

BlueCross BlueShield of Tennessee is sending refunds this month averaging $250 each to about 100,000 Tennesseans. The individuals that bought coverage under the Affordable Care Act health exchange market in 2018 are covered under the program. 

1. ACA rules new programs for healthcare insurer: The Affordable Care Act (ACA) requires that health insurers providing coverage to individual and small group members spend at least 80 percent of collected premiums on health care programs and medical claims. This percentage, or medical loss ratio, is based on a three-year rolling average. If the company misses the spending target, it issues rebates to policyholders.
2. Premium refunded: Under the Obamacare program, health insurers must refund premium income paid by both the government and subscribers if administrative costs and profits exceed 20% of the premiums paid. Last September, BlueCross issued refunds averaging $890 for participants in the individual health exchange markets in 2019.
3. Biggest healthcare market of Memphis: The Chattanooga-based BlueCross and BlueShield is the biggest provider of Obamacare plans in Tennessee, but the insurer did not provide its plans in 2018 in the state’s biggest markets in Nashville or Memphis. The rebate does not cover premiums for other coverage such as dental or vision. And, the biggest share of BlueCross members who are covered through group health plans with their employers or through a Medicare Advantage plan will not receive these rebates.
4. Rebate process in transit: BlueCross spokeswoman Dalya Qualls said the company “is in the process of distributing checks now, and they will all be mailed no later than May 25” and include a letter from BlueCross that explains the rebate. The average refund is$ 250, but some checks may only be as little as $5, depending upon how long and who was covered by the individual plan.
5. Advocates high affordability healthcare: “We continue to center our efforts around supporting the health of those we serve by advocating for affordable, high-quality medical care and using our members’ premiums responsibly,” said Kelly Paulk, vice president of product strategy and individual markets for BlueCross. “The majority of the premiums we collect are used to pay providers for medical and behavioral health care and prescription drugs, and for support services that enhance our members’ health care experience.”