BlueCross Will Mail Rebate Checks by May 25 to 2018 Individual Policy Holders
As a not-for-profit with a mission to serve, we’re here to improve the health of our members and communities. That starts with providing access to affordable, quality health care. But we also have a responsibility to manage operating expenses effectively because we know every dollar we use comes from our customers.
Our biggest priorities are keeping our members healthy and managing the cost of your care.
The Affordable Care Act ACA) says we need to spend 80% of insured medical premiums on health care programs and medical claims. If we spend less than the ACA requires, you and our other members get a rebate based on your adjusted premiums. This is called Medical Loss Ratio, or MLR.
We use the vast majority of your premiums to pay for our members’ medical services or improvements in the quality of care they receive. We use a portion for operating costs like customer service, fraud prevention, digital tools for members, and systems that help pay your claims. Then we pay state, federal and local taxes. Finally, we keep a portion as net income, which goes into our reserves.
In 2019, we paid rebates to people who had individual health plans in 2018. In 2020, the Supreme Court ruled that the federal government owed BlueCross BlueShield of Tennessee $215 million for losses on individual health plans we sold in prior years. As a result of including this payment in our MLR calculations, we owe an additional MLR rebate to members who had individual coverage during 2018.
How did we do in 2018?
|Type of Policy||Our Original MLR||Our Updated MLR|
|Individual policy holders||77.9%||75.3%|
Questions You May Have
Why did I get a check?
We missed the spending target for our individual health policies by 4.7%. And because you had one of those plans in 2018, we’re giving you a rebate. If you received a previous rebate for 2018, we’re sending you the additional amount that we owe you 2.6%).
I had an individual health plan in 2018, but didn’t receive a rebate check in 2019. Why am I getting one now?
We only pay rebates when the amount of the rebate is at least $5. Some people had a rebate under $5 based on our original MLR, so they didn’t receive a rebate check in 2019. But when we updated our MLR, their rebate is now at least $5.
How did you decide on the amount of my check?
We based your rebate on adjusted premiums for your medical coverage in 2018, not how much you actually paid. This means we subtract state, federal and other taxes from the total. Also, the rebate only covers medical plan premiums, not other coverage you may have, such as dental or vision.
Will everyone on my policy get a rebate check?
No. Only the policyholder gets a check, but it applies to the adjusted premiums paid for everyone on your policy.
If you have questions about a rebate for your health policy, please give us a call at 1-888-747-89571-888-747-8957. We’re here Monday through Friday from 8 a.m. to 6 p.m. ET.