Affordable Care Act 2024 Medical Loss Ratio Rebates
August 11, 2025
What Is the Affordable Care Act’s Medical Loss Ratio?
The ACA’s MLR is the percentage of insurance premium dollars a health insurer spends on health care services and expenses reported as activities to improve health care quality.
ACA sets MLR standards for health insurers. For the 2024 MLR reporting year, ACA’s MLR standard for the large group market of a state is 85%. ACA’s MLR standard for the small group markets of a state is 80%. For individual markets, including student health plans, insurers must meet a minimum MLR, which is set at 80%.
If an insurer’s MLR doesn’t meet or exceed the ACA’s MLR standard in a certain market segment of a state, the insurer may provide MLR rebates in that market.
The ACA’s commercial MLR standards apply to certain Fully Insured health insurance coverages in the Group and Individual markets. These standards don't apply to Self-Insured group health plans, or Medicare and Medicaid.
2024 ACA MLR Rebates
After calculating the MLR that applies to your coverage, Blue Cross and Blue Shield of Illinois will provide a prorated MLR rebate to subscribers in student health market plans for the 2024 MLR reporting year.
No other MLR rebates will be provided in relation to any other market segment.
Subscribers enrolled in a student health market plan during 2024 would be eligible to receive a prorated rebate, based on the length of their enrollment during the 2024 calendar year. Any rebate check issued will be mailed directly to the policyholder (subscriber) at the address most recently provided to BCBSIL associated with their coverage. Per Federal regulations, rebates will be made to the policyholder, even if the university paid any of the premiums. Checks are expected to be mailed by the end of September.
For more information, please read Key Questions About the ACA’s MLR.
Key Questions About the ACA’s MLR
Q. What is the ACA’s Medical Loss Ratio (MLR)?
A. The ACA set MLR standards for health insurers. MLR is the percentage of premium dollars that a health insurer spends on health care services and expenses reported as activities to improve health care quality.
For the 2024 MLR reporting year, the MLR standard for the Illinois large group market is 85%. The MLR standard for the individual and small group markets in Illinois is 80%.
The ACA’s commercial MLR standards apply to certain fully insured health insurance coverages in the group and individual markets. They don't apply to self-insured group health plans or to Medicare and Medicaid.
If an insurer’s MLR doesn’t meet or exceed the ACA’s MLR standard in a certain market segment of a state, the insurer may provide MLR rebates in that market.
Q. For purposes of the ACA’s MLR, what types of activities are considered to be quality improvement activities?
A. Among other things, activities to improve quality of care are designed to improve health outcomes for members. For example, these activities may include:
- Enhance patient safety
- Promote health and wellness
- Improve transparency
- Support meaningful use of health information technology, or
- Prevent hospital readmissions
In general, these activities are aligned with criteria developed by professional medical associations, government agencies, accreditation bodies and other nationally recognized health care quality organizations.
Q: Who is eligible for 2024 MLR student health rebates?
A: Active and former Student Health Members who had coverage at some point in 2024 may be eligible for 2024 MLR student health rebates.
According to the Affordable Care Act’s MLR regulations, MLR rebates are not provided when they are below minimum thresholds. Instead, the amounts below these thresholds are aggregated and distributed to those receiving MLR rebates in the relevant market for the MLR reporting year. The minimum threshold for the Student Health market is $5.
Q: When will 2024 MLR student health rebate checks be issued?
A: MLR student health rebates will start being issued in August 2025.
Q: What is the contact information for MLR questions?
A: Student Health Plan subscribers with questions should call BCBSIL at 855-310-0570.