HOI Rebate Sample Notice PDF - Florida Blue

Florida Blue HMOP.O. Box 2210Jacksonville, FL 32203-2210July xx, 2012Notice of Health Insurance Premium RebateSubscriber Name123 Test StreetCity, FL 00000RE: Health Insurance Premium Rebate for Year 2011; Policy # H000000000Dear Subscriber:This letter is to inform you that Florida Blue HMO will be rebating a portion of yourhealth insurance premiums through your employer or group policy holder. Thisrebate is required by the Affordable Care Act - the health reform law.The Affordable Care Act requires Florida Blue HMO to rebate part of the premiumsit received if it does not spend at least 85 percent of the premiums Florida BlueHMO receives on health care services, such as doctors and hospital bills, andactivities to improve health care quality, such as efforts to improve patient safety.No more than 15 percent of premiums may be spent on administrative costs suchas salaries, sales and advertising. This is referred to as the "Medical Loss Ratio"standard or the 85/15 rule. The 85/15 rule in the Affordable Care Act is intendedto ensure that consumers get value for their health care dollars. You can learnmore about the 85/15 rule and other provisions of the health reform law at:http://www.healthcare.gov/law/features/costs/value-for-premium/index.html.What the Medical Loss Ratio Rule Means to YouSAMPLEThe Medical Loss Ratio rule is calculated on a State by State basis. In Florida,Florida Blue HMO did not meet the 85/15 standard. In 2011, Florida Blue HMOspent only 81.7% of a total of $282,893,931 in premium dollars on health care andactivities to improve health care quality. Since it missed the 85 percent target by3.3% of premium it receives, Florida Blue HMO must rebate 3.3% of the totalhealth insurance premiums paid by the employer and employees in your grouphealth plan. We are required to send this rebate to your employer or group policyholder by August 1, 2012, or apply this rebate to the health insurance premiumthat is due on or after August 1, 2012. Employers or group policyholders mustfollow certain rules for distributing the rebate to you.Ways in Which an Employer Can Distribute the RebateIf your group health plan is a non-Federal governmental plan, the employer orgroup policyholder must distribute the rebate in one of two ways: