Cigna must pay $2.6 million in rebates to nearly 10,600 health insurance consumers in Maine because it failed to meet a federal requirement to spend 85 percent of the premiums it collected last year on medical care.

Connecticut-based Cigna is the only health insurer operating in Maine that must pay rebates, which will average $463 per family, according to the U.S. Department of Health and Human Services.

A provision in the federal Affordable Care Act requires insurers to spend certain amounts on medical care, with a minority of their spending allocated to administrative expenses such as salaries and marketing.

The rules for so-called Medical Loss Ratios require insurance companies for small groups to spend at least 80 percent of their premiums on medical care. Providers of insurance for large groups must spend at least 85 percent on care.

The Department of Health and Human Services says insurance companies submitted reports June 1 for coverage they provided last year.

The department says health insurance companies nationwide will pay more than $1.1 billion in rebates to nearly 12.8 million Americans. The rebates, the first round triggered by the Affordable Care Act, must be paid by Aug. 1.

Cigna’s average rebate of $463 in Maine is the fourth-highest in the nation for the large-group insurance market, according to the Department of Health and Human Services.

Cigna declined to comment Tuesday.

In a prepared statement, U.S. Rep. Mike Michaud of Maine said, “Health premiums should reflect how much insurance companies are actually spending on care, and this provision will provide relief to Mainers who have seen their insurance costs skyrocket while their health care services stay the same.”

Most of the 10,589 consumers in Maine won’t see checks in the mail. Instead, rebates will go to the employers who administer the insurance plans, then get passed directly to the employees or used to reduce the employees’ health insurance costs, Michaud said.

“This is another example of the Affordable Care Act working for consumers,” said Mitchell Stein, policy director for Consumers for Affordable Health Care. “We look forward to a time when none of the companies must pay a rebate.”

Maine got a waiver of the rule for the individual insurance market, so only people who are insured through group policies are covered by the Medical Loss Ratio rules in this state.

Maine requested the waiver for the individual market after Megalife indicated it might leave the market if it had to spend 80 percent of its premiums on medical care. Companies that sell individual insurance will be required to direct only 65 percent of their premiums to medical care until the end of 2013.

 

Staff Writer Jessica Hall can be contacted at 791-6316 or at: [email protected]