By Sharon Salyer Herald Writer
In Alaska, the average health insurance rebate check to consumers is $622.
In Oregon, it’s $777.
In Washington, the rebate for many consumers is: Zip. Zero. Zilch.
There is a good news side to this no-check-is-in-the-mail story, however.
This year, for the first time, health insurance plans were required by federal law to rebate money to consumers if they didn’t meet the minimum spending requirements for medical care.
“This is making a national standard to make sure people in every state are getting the best health care for the dollars they spend,” said Stephanie Marquis, spokeswoman for the state Insurance Commissioner.
The requirement is just one part of the federal Affordable Care Act, upheld by the U.S. Supreme Court in June.
Health plans that didn’t meet the requirement had until Aug. 1 to send a check. So, if you haven’t yet gotten a check, you probably won’t be getting one.
Nationally, nearly 13 million consumers are getting rebates of more than $1.1 billion, according to the federal Department of Health and Human Services. The average family rebate is $151.
Not all Washington consumers are shut out of the rebates. Statewide, 7,681 consumers will be getting an average of $185. Those people have insurance other than through the three largest health plans.
“We have heard from some people who were curious and wanted to know if they would be getting something back,” Marquis said.
Companies had to tell consumers whether they were getting a check, she said. “We have had a little confusion about that.”
Instead of a check, the state’s three largest health plans, covering more than 3 million people, will simply be sending out a letter. It probably includes the term for determining who gets a check and who doesn’t, called medical loss ratio.
Just how much health plans were required to spend on health care depends on whether it’s an individual, small group or large group plan — 80 percent of premiums must go to medical costs in small group and individual plans and 85 percent in large group plans.
Small group plans cover up to 50 employees.
Regence, which has 977,000 members in Washington, spent 87 percent of individual plan premium costs on medical care, 83 percent of small group premiums and 88 percent of large group premiums, said Rachelle Cunningham, a Regence spokeswoman.
Premera has 1.5 million Washington members. It spent 95.8 percent of individual health plan premiums on health care (84.9 for individual LifeWise members), 88.3 percent of small group premiums (80 percent for LifeWise members) and 87.8 percent of large group premiums, said Amy Carter, a Premera spokeswoman.
Group Health spent 96.7 percent of individual premiums on health care, 82.9 percent of small group premiums and 88.9 percent of large group premiums, according to Michael Foley, a Group Health spokesman.
Although members will be getting a letter in lieu of a rebate check, “It’s good news that we spend such a large proportion of our resources on medical care,” he said.
In 2001, Washington enacted a law requiring health plans to spend at least 72 percent of premiums on medical costs. However, it only applied to organizations selling individual health plans. Currently, about 300,000 people are covered by individual health insurance plans.
Health plans have been exceeding that standard for some time, Marquis said.
Earlier this year, other changes took effect as part of the Affordable Care Act. Those include: a ban on excluding children from health insurance plans due to serious, pre-existing medical conditions; lifting lifetime limits on health expenses; and allowing children to remain on their parent’s health insurance plan until they turn 26.
Another group of changes is scheduled to take effect in 2014. They include: online shopping sites in each state for individual and small group health insurance plans, and a ban on denying health care coverage to adults with serious health conditions, Marquis said.
Sharon Salyer: 425-339-3486 or email@example.com
Average rebates for each state under individual, small group and large group insurance plans can be found on the federal website: tinyurl.com/HCR-rebates