Question 1

What is a Medical Loss Ratio (MLR) Rebate?

Accepted Answer

The Medical Loss Ratio (MLR) rebate is a refund mechanism required by the Affordable Care Act (ACA). It’s not a direct reward for running a wellness program, but it can provide extra funds if your insurer hasn’t spent enough on medical care and quality improvements.
 • How it works: Insurers must spend at least 80% of premiums on medical care for small group plans (85% for large group plans).
 • The rebate trigger: If the insurer spends less than this percentage (measured over a three-year average), they must issue a rebate to the policyholder — usually the employer.

Question 2

How can employers use MLR rebates?

Accepted Answer

• If the employer pays 100% of the premiums, they can keep the full rebate and use it as they see fit — including funding wellness programs like ours.
 • If premiums are shared with employees, the portion tied to employee contributions must go back to them (e.g., via check or future premium credit).

Question 3

How does a wellness program tie into MLR rebates?

Accepted Answer

Our corporate wellness programs can support the insurer’s “health improvement activities” category, which strengthens the case for using any future rebates for wellness initiatives. Essentially, it helps employers demonstrate that they’re investing in programs that improve employee health and reduce healthcare costs.

Question 4

What are Wellness Program Incentives?

Accepted Answer

These are voluntary programs offered by insurers or employers that provide financial rewards for employees who engage in healthy behaviors.
 • How they work: Programs can reward employees for participation (e.g., attending fitness classes) or achieving outcomes (e.g., completing a health screening).
Common incentives include:
 • Premium Discounts: Lower monthly health insurance costs for participating in wellness activities.
 • HSA/HRA Contributions: Funds added to an employee’s Health Savings Account or Health Reimbursement Arrangement.
 • Cash or Gift Cards: Rewards for reaching wellness goals.
Fitness Reimbursements: Reimbursement for gym memberships or fitness classes.

Question 5

How does Breakthrough Wellness help qualify for these incentives?

Accepted Answer

Our programs provide high participation rates and measurable ROI data, which HR teams can use to demonstrate employee engagement and justify incentives from their insurance provider. The post-event or monthly reports we provide make it easy to track participation, satisfaction, and impact.

Breakthrough Wellness FAQs

How Wellness Programs Can Interact with Health Insurance Rebates