KC Health Care Reform

According to the Affordable Care Act’s Medical Loss Ratio (MLR) requirements, insurers are required to spend at least 80 percent in the individual and small group market of each premium dollar on care their members receive or improving the quality of that care. Insurers must spend at least 85 percent in the large group market. Insurance companies who do not meet the MLR standard are required to issue rebates to their members in 2012.

We believe that MLR requirements do not address the underlying cause of persistently rising healthcare costs.

Our primary commitment at Blue KC is ensuring that our members receive proper healthcare at the time and place they need it and at a reasonable price. We know that when our members buy insurance, they are buying comfort and peace of mind knowing that they will be able to pay for their healthcare needs whenever they arise. Although some members will receive premium rebates this year, we know that these rebates cannot provide long-term healthcare security for our members by controlling rising healthcare costs.

If we want to guarantee high-quality, affordable healthcare for all Americans, we must take the necessary steps to control the ever-increasing medical costs. These steps include changing the way healthcare is delivered, meaning more emphasis on primary and preventive care as well as government assistance to eradicate avoidable errors, infections and complications. In addition, we must change the incentive structure in our healthcare system to reward superior care.

Blue KC is leading efforts to control healthcare costs and encourage families to make healthier decisions and focus on preventive and primary care. We are promoting healthier lifestyles and combating the obesity epidemic by encouraging families to take preventative measures such as changing eating habits and getting more exercise. In addition, we have taken steps to: improve information technology to help doctors understand and communicate with patients better, base payment of doctors and hospitals on the quality of care delivered, and improve coordination of family doctors, specialist and other care providers to ensure the best possible care at the lowest possible cost. Blue Cross and Blue Shield of Kansas City is focused on providing more affordable, safer and higher quality healthcare for our members.

Facts About Rebates

• Some individuals will receive rebates, others will not. It depends on factors including each insurer’s market segment and individual state.
• Rebate determinations will be finalized June 1, 2012 and exact rebate amounts will not be known until that time.
• Consumers will be notified by their insurance company or employer if they will be receiving a rebate.
• Consumers will receive rebates by August 1, 2012.