At Blue Cross and Blue Shield of North Carolina (Blue Cross NC) we continue to ensure that we are giving our members the most value their plans have to offer. So this year we will be distributing Medical Loss Ratio (MLR) rebates to all eligible subscribers for the 2019 plan year. If you have received a notification about a rebate, you can expect to receive a refund in the fall of 2020.
- Why is MLR important?
Under the ACA, insurance companies have to report their MLR. If an insurer doesn’t meet their MLR, then their members qualify for a rebate.
- When is MLR determined?
MLR for this year (2020) will be calculated based on the 3-year weighted average for years 2017, 2018, and 2019.
- How will I know if I'm eligible for a rebate?
All eligible subscribers will be notified or receive a rebate by September 30.
- When will I get my rebate?
All rebates will be issued to eligible subscribers by September 30.
- How will I get my rebate?
Blue Cross NC will mail notices of rebates to individual subscribers. If you have a premium that is less than the amount of the refund or you are no longer with Blue Cross NC, you’ll receive a check in the mail. If you have a premium that is larger than your refund amount, you will receive a credit to your account in October of 2020. Student Blue members will receive checks.
- Can I switch to a rebate check instead of the credit?
No. Whether you receive a rebate check or credit is based on your monthly premiums and refund amount.
- Do I need to do anything to get my rebate?
You don’t have to do anything. Eligible subscribers with individual plans will receive checks or invoice credits directly. In order to ensure proper delivery, please check that all your contact information and address are up to date. If you are an Individual member who purchased your own health plan, log into Blue Connect to confirm and update your information. If you are a Student Blue member, please call 1-833-397-3777 to update your address.
- My neighbor/friend/co-worker received a rebate. Why didn't I receive one?
It all depends on the health plan the member is enrolled on. Your friend's rebate arrival and amount may be different from yours if you’re on different plans.
- What if my check is lost in the mail?
If you believe you are eligible for a rebate, you should call the Member Services telephone number on the back of your member ID card to confirm that you have the correct address on file.
- How are rebates calculated?
MLR rebates are determined by taking the amount spent on medical claims and qualified health quality initiatives and dividing it by the premiums collected, minus certain federal and state taxes and fees.
- What are the tax implications of receiving a rebate?
You should consult with your tax advisor to find out if there are any tax implications. Blue Cross NC does not offer tax guidance.
- Why did some insurers not meet the minimum MLR threshold?
Insurers typically file proposed premiums with state regulators as early as nine months before new prices take effect. These proposed premiums are based on estimates of medical spending to cover the expected cost of future claims costs. In short, it's difficult to set the exact right prices to avoid paying rebates
- Why wasn't my rebate larger?
Rebates depend on the product you have, the length of time you were enrolled and the amount of premium you paid during 2019.
- Can I appeal the rebate amount I received?
No. Because your rebate is calculated using specific criteria required under the law and federal regulation, ACA does not offer an appeals process. The amounts used in calculating rebates are filed with and subject to review by federal and state regulators.
- How large is the typical rebate?
There is no "typical" rebate size because amounts will vary as a result of product, length of time and premiums paid.
- Does this mean Blue Cross NC will reduce my future premiums?
Blue Cross NC strives to offer products at a price that sufficiently covers the costs to administer and pay our members’ health care claims with a small margin to reserve for the future protection and benefit of members. We will always seek to ensure that premiums track closely to actual and anticipated medical spending trends.
- If I am no longer with Blue Cross NC in 2020, will I still receive my rebate for the year I was covered?
Yes. Even subscribers who ended their Blue Cross NC coverage can receive rebates if they were covered for any portion of 2019.
- What if I changed Blue Cross NC health plans during the rebate year?
Rebates can vary depending on how much of the year you were covered by a rebate-eligible plan.
- Since I received a rebate this year, am I likely to receive one next year?
MLR rebates are calculated based on a complex set of costs and fees paid that change every year. Receiving a rebate this year does not increase your chances for future rebates.
- Do subscribers over the age of 65 get a rebate?
Medicare has different MLR filing processes. Medicare Supplement members do receive rebates when we don't meet MLR targets. Medicare Advantage and PDP do not receive rebates directly. The Centers for Medicare and Medicaid Services receive that rebate, if applicable.