State law says health insurers in Massachusetts must spend at least 88% of every premium dollar on medical services. Last year, members used less care than insurers had collected money to cover, so most of the state’s largest health plans are returning the difference. Nationally, health plans are expected to return $1.3 billion.
Rebates for individuals who buy insurance on their own will range from $100 (on average from Tufts Health Plan) and $260 (from Harvard Pilgrim Health Care). Employers who buy group plans can expect a credit of between $600 (Harvard Pilgrim) and $1,700 (Tufts) in their July bill. Fallon Community Health Plan says its average rebate is $425 (they don’t separate by group and individuals). Employers are expected to share the refund with employees who pay part of their premium cost.
Health insurers say Massachusetts has the toughest medical spending rules in the nation. Federal law requires health plans to spend at least 80% of the premium dollar on care.