MMO Medical Loss Ratio (MLR) Rebate Checks Issued to Medical Mutual Individual and Small Group Polic

09-30-2025

 The Affordable Care Act (ACA) includes a medical loss ratio provision. Medical loss ratio, or MLR, is the percentage of premium dollars an insurance company spends on medical services like claims and health and wellness programs.

The ACA requires health insurers to spend 85% of premiums received from large, fully insured employers (51+ employees) and 80% of premiums received from small, fully insured employers (1 to 50 employees) and individual product plans, toward medical expenses. The types of services that qualify as medical expenses include treatments, hospital admissions, doctor appointments, and programs to improve the quality of care our members receive. The remaining 20% or 15% we receive in premiums can be spent on administrative expenses like salaries, marketing and facility expenses.

By Sept. 30, 2025, health insurers not meeting the MLR criteria for fiscal year 2024 must pay rebates to impacted policyholders, both current and canceled (if they paid for coverage in 2024).

For fiscal year 2024, Medical Mutual is required to pay rebates to Medical Mutual individual policyholders and small groups of one policyholder who had coverage during 2024. We have mailed a letter to notify members. The rebate check has been mailed separately. Both were mailed to the policyholders in advance of the Sept. 30, 2025, due date.