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.
