Individuals, businesses to get $21.5 million in health insurance rebates

DOVER — After announcing a reduction of Delaware Health Insurance Marketplace rates for the upcoming enrollment year, state Insurance Commissioner Trinidad Navarro said there is more good news for residents who purchase insurance on the marketplace, for those who purchase Highmark Blue Cross Blue Shield Delaware plans outside of the exchange in the individual market and for Highmark small-group policyholders, announcing more than $21.5 million in rebates for 2019 participants.

Trinadad Navarro

“Now, more than ever, we need to make sure that every resident and small business can afford the health insurance they need for their families and employees. These rebates, combined with the (Affordable Care Act) health insurance rate reduction for the coming year, do just that,” said Mr. Navarro. “This is just one of many ways we are working to reduce the cost of care our residents experience in the health care system.”

For the first time in the history of Delaware’s individual health insurance market, more than $12.6 million will be returned to 19,273 policyholders, with the average rebate being $656.

Highmark small groups, often small businesses, will receive more than $8.8 million in cumulative return. A total of 2,779 groups will receive an average rebate of $3,198, with more than 175 groups receiving rebates over $10,000. Employers can consider using these dollars to enhance benefits, reduce premiums for employees in future policy years or provide refunds directly to group health plan participants.

Communications will be sent to policyholders in September, and checks for both individual policyholders and small groups will be sent the week of Sept. 21. Those in the individual market with rebate questions can contact Highmark at (800) 544-6679. Small-group employers with rebate questions can contact their insurance producer or Highmark at (800) 241-5704.

These rebates are required by the Delaware Department of Insurance according to medical loss ratio measurements set by the Affordable Care Act. These measurements are meant to ensure that insurers are spending a majority of premiums on health claims and clinical services, not taking those dollars for profit or administrative expenses.

The rebate system creates balance when data shows that this ratio was off in a previous year. Not every policy will receive a rebate. MLR review for the 2020 plan year will shine a light on changes in insurance usage due to COVID-19 and will be released in 2021.

On Monday, Mr. Navarro announced that the Delaware Health Insurance Marketplace would see an average decrease in rates of 1% for individual plans. Highmark small-group plans will see an average premium decrease of 3%.