Blue Cross Will Mail Rebate Checks by Sept. 30 to Individual Policy Holders & Small Group Employers

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 a certain percentage 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. 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 (profit), which goes into our reserves. In 2018, across our entire business, only 4 cents of every premium dollar we received was profit.

How did we do in 2018?

Type of PolicyOur Actual MLROur Required MLR
Individual policy holders 77.9% 80%
Small groups (up to 50 employees) 79.8% 80%
Large groups (51+ employees) 87.7% 85%


Information for Individual Policy Holders

Why did I receive a check?
We missed the spending target for our individual health policies – both on and off the marketplace – by 2.1%. And because you had one of those plans in 2018, we’re giving you a rebate.

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 premiums paid for everyone on your policy.

Information for Small Employers

Why did I receive a check?
We missed the spending target for our small group health plans by 0.2%. And because you had one of those plans in 2018, we’re giving you a rebate.

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.

How can my company use our rebate?
We sent a letter to employers that received a rebate check with information on how you can use this rebate. We’ve also worked with a legal partner to create an FAQ, which you can find in your employer BlueAccessSM portal. This FAQ contains general information. Please ask your legal counsel any specific questions you have about how to use your rebate.

Why did my premium increase if my company is receiving a rebate?
Rebates are based on our performance in the previous year. Premium increases are based on future projections that include changes in our members’ health and increasing costs paid to providers and health care facilities. Premiums also usually increase with age.

Information for Employees of Small Employers

My employer got a rebate, but I didn’t. Why not?
We can only pay rebates to the policyholder, which in your case, is your employer.* In most cases, your employer still has to use this rebate on your care—lowering your premium, increasing your benefits, etc. But please ask your employer if you’d like to know how they plan to use their rebate.

Questions?

If you have questions about a rebate for your health policy, please give us a call.

  • Members with individual policies: 1-888-747-8957 (TTY: 1-800-848-0298 or 711)
  • Small employers: 1-888-924-2271 (TTY: 1-800-848-0298 or 711)
  • Employees of small employers: Please call the Member Service number on the back of your Member ID card

We’re here Monday through Friday from 8 a.m. to 6 p.m. ET.

*In some rare cases, employees may get a rebate check if the employer that provided their coverage has gone out of business, etc.