MLR rebate calculator: how much could your group get back?
Enter your annual premium and the insurer reported medical loss ratio to estimate a rebate. Then see how much of it relates to employee contributions. Built for HR and finance teams.
Estimate a medical loss ratio rebate.
Use the MLR from your insurer rebate notice or the CMS data. The result updates as you type.
This is the insurer result for the whole market, not your own claims.
Used to split the rebate between employee and employer contributions.
Your estimate
An estimate from the figures you enter. Your insurer sends the official rebate notice. How a rebate may be used depends on your plan documents, so review it with counsel.
What is a medical loss ratio rebate?
Federal rules require insurers to spend a minimum share of premium on medical care and quality improvement. The minimum is 80 percent in the individual and small group markets and 85 percent in the large group market. An insurer that falls short must rebate the difference to policyholders, generally by September 30. The result is measured across an insurer book of business in a state and market, so a group with low claims of its own does not get a larger rebate.
Who gets the rebate on a group plan?
The policyholder receives it, often the employer. Department of Labor guidance says the part tied to employee contributions is generally a plan asset that should benefit participants, unless the plan documents say otherwise. Common uses are a premium credit or a benefit enhancement. Self-funded plans do not receive these rebates.
Common questions
Is the rebate based on our own claims?
No. The loss ratio is calculated for the insurer in each state and market, so your group does not earn a rebate because its own claims were low. Every policyholder in that market gets the same percentage.
When do rebates arrive?
Insurers generally pay them by September 30 for the prior reporting period. You can receive a check, a premium credit or a payment to an account, depending on the insurer.
Can we keep the whole rebate?
Not always. The share tied to employee contributions is generally treated as a plan asset to be used for employees, unless plan documents provide otherwise. Ask counsel how to allocate it.
Where do I find the insurer MLR?
The rebate notice shows it. CMS also publishes MLR data by insurer, state and market.
Talk to us about your renewal
Book a 30-minute call and we will look at your renewal, your premium and the options that fit. Visit us at 41000 Woodward Avenue, Suite 350 East, Bloomfield Hills, MI 48304, or call 248.370.8853.
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Laws and rules referenced
42 U.S.C. § 300gg-18 — Medical loss ratio and rebate requirement
45 CFR Part 158 — Issuer use of premium revenue and rebates
45 CFR 158.210 — Minimum MLR of 85 percent large group, 80 percent small group and individual
This tool gives estimates for education, not tax or legal advice. Rules change, so confirm your situation with a qualified advisor.
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