Published July 24, 2012
Next week, rebates will go out to small-business owners, the Columbia-based health insurance and information technology company said Monday.
Rebate amounts are based on overall claims for 2011 and other complex calculations by which the federal government has established medical loss ratios, or MLRs.
That means an insurer had to use 80 cents out of every dollar submitted in premiums to pay customers’ medical claims and for other specific activities. BlueCross is issuing rebates in those markets because it fell slightly below the 80% target.
No large groups are eligible for rebates since BlueCross did meet the large group target of 85%.
Rebate amounts vary from group to group and member to member. Most payouts are less than $200. Rebates are being mailed directly to members with individual policies and to small-group employers. The federal government defines small groups as those with two to 50 full- and part-time employees, including seasonal help.
Small-group employers have the option of returning a portion of the rebates to their employees or reinvesting it in the company to offset future health care costs.
BlueCross did not release the total amount of rebates being issued in South Carolina.
Jim Deyling, president of private business at S.C. BlueCross
Jim Deyling, president of private business at BlueCross BlueShield of South Carolina, said governmental MLR requirements do not address the root cause of rising health care expenses.
“We are complying with the law, but our concern remains that a rebate such as this not only creates a false impression of overpricing, but also reveals the fundamental flaw of the legislation, which is that it does nothing to reduce health care expense for members,” Deyling said.
“In addition to keeping our profit margins below 3%, we want our customers to know that BlueCross BlueShield of South Carolina continues to be innovative in our approach to reducing rising health care costs,” Deyling said.
“We are actively working with providers and employers to identify ways to keep premiums as affordable as possible,” Deyling said. “We are also leading the way in rewarding providers for the quality of health care services they provide rather than the quantity of those services. We believe these efforts will make our members healthier in the long run as well as reduce costs.”
BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. It is the only South Carolina-owned and operated health insurance carrier, comprising more than 40 companies involved in health insurance services, U.S. Department of Defense health program and Medicare contracts, other insurance and employee benefits services, and a philanthropic foundation that funds programs to improve health care and access to health care for South Carolinians.
BlueChoice HealthPlan of South Carolina, a subsidiary of BlueCross BlueShield of South Carolina, also is an independent licensee of the Blue Cross and Blue Shield Association.