The $12.3 million in rebates are the result of medical loss ratio calculations, according to the announcement. Under the ACA, payers must spend at least 80 percent of premiums on services for policyholders, and must issue refunds if that threshold is not met.
Residents who enrolled in plans through Delaware’s state marketplace or are enrolled in a Highmark plan outside of the marketplace are eligible for reimbursement.
The state estimates nearly 21,000 individual residents will receive $8.4 million in reimbursements, with the average policyholder receiving $405. Those in small group plans are tapping $3.9 million in cumulative funds, boiling down to a $1,514 average reimbursement for 2,573 groups.
Checks will be sent to policyholders the week of Sept. 15.
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