Blue Shield of California Small Business Market - Medical Loss Ratio (MLR) Rebates

The Affordable Care Act requires Blue Shield of California (Blue Shield) to refund part of the premiums it receives if it does not spend at least 80% of premiums received for small group plans and 85% of premiums received for large group plans on medical care such as doctors and hospital bills, and activities to improve health care quality, such as patient safety. This requirement is referred to as the “Medical Loss Ratio” standard or the “80/20 rule.” This rule is intended to ensure that consumers get value for their healthcare dollars.

Blue Shield does not owe Medical Loss Ratio rebates for 2023 to employer groups since Blue Shield exceeded the MLR targets.