Potential Rebates Saved by HHS Determinations

Potential Rebates Saved by HHS Determinations

Note: These estimates are provided from 2010 data. Final amount of rebates will vary with market conditions and may be lower as insurance companies lower premiums for consumers to meet the MLR standard.

2011 Issuer MLR Rebate Estimates in States that Applied for an MLR Adjustment[*]

StateState MLR Adjustment Requested (2011)Potential Rebate Amount at State Requested MLR Adjustment (in $ Millions)State MLR Approved by HHS (2011)Potential Rebate Amount based on HHS Approved MLR (in $ Millions)Difference between State MLR Adjustment Requested and HHS Approved MLR
Maine [1]65%$-65%$-$-
New Hampshire70%$4.0072%$5.80$1.80
Kentucky [1]65%$-75%$1.30$1.30
North Dakota [2]60%$0.4080%$2.70$2.30
Iowa [3]60%$0.6067%$1.00$0.40
Guam [4]65%$-80%$-$-
Geogia [5]65%$2.5070%$4.40$1.90
Florida [6]68%$0.6080%$107.20$106.60
North Carolina72%$4.2075%$7.00$2.80
Total $61.00 $384.10$323.20

[*] Unless otherwise noted, these estimates are based on SHCE data supplemented with data provided by the State Dept. of Insurance.

[1] ME, KY: estimates based on DOI estimates

[2] ND: estimates based on DOI’s rebate estimates under an 80% MLR, but we used 2010 SHCEs to calculate estimates under a 65% MLR (DOI had no estimate for rebates under a 65% MLR).

[3] IA: estimates based on DOI’s rebate estimate under a 60% MLR, but we used 2010 SHCEs to calculate estimate under a 67% MLR.  

[4] Issuers in Guam are presumed to meet the standard as no issuer in the individual market is poised to become credible.

[5] GA: estimates based on DOI’s data to supplement 2010 SHCEs to estimate rebates, except where 2010 SHCE MLR’s were used to estimate issuer rebates because no estimate for that issuer’s MLR was provided by the DOI’s.  However, in the determination letter, CCIIO cited estimates under an 80% standard which was calculated using 2010 SHCEs because those estimates were more conservative than the issuer’s estimates under 80%.

[6] FL: estimates based on DOI’s estimate under 71% MLR and 2010 SHCEs to estimate rebates under 80%.

Page Last Modified:
09/06/2023 05:05 PM