NC consumers to get $8.5M in health insurance rebates

Posted November 23, 2015 3:08 p.m. EST

— Health insurers will have to give $8.5 million in premiums back to individual and business customers for failing to meet requirements of the Affordable Care Act, state Insurance Commissioner Wayne Goodwin said Monday.

Under the federal health law, insurers must spend at least 80 percent of their premium revenue – 85 percent for large-group policies – on paying medical claims and improving the quality of health care for customers. No more than 15 to 20 percent can be spent on administrative costs.

Insurers that fail to meet the standard owe policyholders a refund. Refunds are paid directly to consumers who purchase their own insurance or to employers for company-sponsored plans, and the companies then forward the rebates to their workers.

United Healthcare is responsible for the majority of the rebates – $4.1 million for small-group policies and $777,000 for large-group policies – for missing the guidelines in 2014. Coventry Health and Life Insurance owes about $833,000 in refunds, while CIGNA owes almost $589,000.

Other companies owing refunds in North Carolina include Golden Rules Insurance, Connecticut General Life Insurance, Mid-West Life Insurance and Madison National Life Insurance.