SD families to receive insurance rebates - KOTA Territory News

SD families to receive insurance rebates


Thursday, Health and Human Services (HHS) Secretary Kathleen Sebelius announced that 784 South Dakota residents will benefit from $41,240 in rebates from insurance companies this summer, averaging $70 per family, thanks to the Affordable Care Act.  


Nationwide, 77.8 million consumers saved $3.4 billion up front on their premiums as insurance companies operated more efficiently.  Additionally, consumers nationwide will save $500 million in rebates, with 8.5 million enrollees due to receive an average rebate of around $100 per family. 


Created under the Affordable Care Act, the Medical Loss Ratio standard (also known as the "80/20 rule") requires insurers to spend at least 80 cents of every premium dollar on patient care and quality improvement.  If they spend an excessive amount on profits and red tape, they owe rebates back for the difference no later than August 1, 2013.   

"This new standard is increasing transparency and accountability, promoting better business practices and competition among insurance companies, and ensuring consumers receive value for their premium dollars," said Secretary Sebelius.  "Today's announcement shows that more South Dakotans are benefiting from the tools created under the Affordable Care Act to keep consumer costs down."


The law has motivated many plans to lower prices or improve their coverage to meet the standard. Other South Dakotans will see their value reflected through rebates later this summer. 

South Dakotans owed a rebate will see their value reflected in one of the following:


  • a rebate check in the mail
  • a lump-sum reimbursement to the same account that they used to pay the premium if by credit card or debit card
  • a reduction in their premiums
  • their employer using rebates to improve their health coverage


Insurance companies that do not meet the standard will send consumers a notice informing them of the rule  The notice will also let consumers know how much the insurer did or did not spend on patient care or quality improvement, and how much of that difference will be returned as a rebate. 


The 80/20 rule works, along with the required review of proposed double-digit premium increases, to stabilize and moderate premium rates.  And, with new market reforms, including the guaranteed availability protections and prohibition of the use of factors such as health status, medical history, gender and industry of employment to set premiums rates, this policy helps ensure every American has access to quality, affordable health insurance.

For an overview of insurers' MLR data in 2012, please visit: Loss Ratio


For more information on the MLR provision in the Affordable Care Act:


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