2019 Additional Medical Loss Ratio (MLR) Rebate Information

Massachusetts and Federal Information

February 01, 2023  

Massachusetts and Federal law (Affordable Care Act) requires that health insurance companies spend a minimum percentage of premium dollars on medical claims, including clinical services and activities designed to improve health care quality. This percentage is known as the minimum Medical Loss Ratio (MLR). If a health insurer does not meet the minimum MLR requirement, the insurer must issue rebates to all employers within the affected line of business.

The MLR standard applies to health insurance plans offering group or individual coverage. It does not apply to self-insured plans.

In 2020, Tufts Associated Health Maintenance Organization, Inc. (TAHMO) rebated a portion of health insurance premiums collected in 2019. It was recently determined that TAHMO owes additional rebates and interest due to all Massachusetts employer groups and individuals who received 2019 MLR rebates in 2020. Tufts Health Plan Massachusetts and Federal MLR rebates and notification letters will be sent to impacted employer groups and individuals, postmarked by February 28, 2023.

Please note: Only Massachusetts Commercial HMO, POS, and PPO products underwritten by TAHMO are eligible for this additional rebate. Please refer to the resources below for more details.

Employer Notification Letters

Subscriber Notification Letters




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