Over 235,000 Arizona families will be getting a check for about $120 this summer thanks to the Affordable Care Act’s 80/20 rule.
The 80/20 rule requires insurance companies to spend at least 80 percent of consumers’ premium dollars on medical care. If they don’t, they have to reimburse the difference.
“The Affordable Care Act requires insurance companies to spend 80 percent of what it receives in the way of premiums for actual claim,” said Arizona State University law professor James G. Hodge Jr. “When you have a situation where an insurance company is charged more in premiums than it is disbursed in claims, the [act] requires a refund.”
The rule also states how much of consumers’s claims can be used by insurance companies on non-health care costs. Hodges said the rebates could continue on for years.
“You will see a lot of insurance companies — if this provision stays in place following the Supreme Court’s review — making these adjustments so they don’t have to engage in this type of systemic refund across a large pool,” he said. “Ultimately, it could be an annual reimbursement made to consumers.”
Insurance companies are required to provide the rebates no later than Aug. 1.
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