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Affordable Care Act (ACA) Refiled 2018 Medical Loss Ratio (MLR)
Blue Cross and Blue Shield of Texas (BCBSTX) will provide MLR rebates in the Texas individual market for the 2018 MLR reporting year.
We received a one-time payment from the federal government that impacted our 2018 MLR in this market. As a result of the payment, we amended and refiled our 2018 MLR report consistent with guidance from the Centers for Medicare & Medicaid Services (CMS) and are providing additional MLR rebates for the 2018 MLR reporting year.
In our original MLR report filing for 2018, we didn't meet the MLR standard in the Texas individual market and provided MLR rebates in that market for that year.
Key Questions About the ACA's Refiled 2018 MLR
Q. What is the ACA's MLR?
A. In general, the ACA's MLR is the percentage of insurance premium dollars that a health insurer spends on health care services and expenses reported as activities to improve health care quality.
The ACA set MLR standards for health insurers. In Texas, the ACA's MLR standard for the large group market was 85 percent for the 2018 MLR reporting year. The ACA's MLR standard for individual and small group markets was 80 percent.
The ACA's commercial MLR standards apply to certain fully insured health insurance coverages in the group and individual markets. If an insurer's MLR doesn't meet or exceed the ACA's MLR standard in a certain market segment of a state, the insurer may provide MLR rebates in that market.
Q. Why are you providing MLR rebates in the Texas individual market?
A. We are providing MLR rebates in the Texas individual market because we received a payment from the federal government that impacted our 2018 MLR in this market. As a result of this payment, and consistent with CMS guidance, we amended and refiled our 2018 MLR report.
Q. Did you previously provide MLR rebates for the 2018 MLR reporting year in the Texas individual market?
A. Yes. We provided MLR rebates in 2019 in the Texas individual market for the 2018 MLR reporting year. Find details here about those rebates.
Q. How will any MLR rebates be provided?
A. In general, MLR rebates will be provided in the form of a check or premium credit.
Q. For purposes of the ACA's MLR, what types of activities are considered to be quality improvement activities?
A. Among other things, activities to improve quality of care are designed to improve health outcomes for members. For example, these activities may include:
- Enhance patient safety
- Promote health and wellness
- Improve transparency
- Support meaningful use of health information technology, or
- Prevent hospital readmissions
In general, these activities are aligned with criteria developed by professional medical associations, government agencies, accreditation bodies and other nationally recognized health care quality organizations.
Find details here about MLR rebates for the 2019 reporting year.