Blue Shield of California is paying money it owes to about 240,000 people with job-based health coverage, according to a California Healthline report.
Here are six things to know about the issue.
1. The insurer owes almost $25 million this year to California enrollees and their employers.
2. To start paying what it owes, Blue Shield of California has sent refund checks to the individuals' employers. The employers then had to calculate how to distribute the money to workers based on their share of 2015 premium payments, according to the article.
3. According to California Healthline, some employers could hold onto the refund, if they paid their employees' entire premiums.
4. This year's refund checks from Blue Shield of California come as the insurer is already under scrutiny from the California Department of Managed Health Care. California Healthline reports that for the 2014 plan year, the insurer paid more than $85 million to California customers for overpaid premiums. A lawsuit was filed against the insurer, alleging it shortchanged consumers on the rebates it paid consumers that year, according to the report, and the California Department of Managed Health Care said it is still looking into a complaint filed on the matter.
5. Blue Shield of California must refund money to consumers because it didn't meet the "medical loss ratio," which requires insurers covering small businesses and individuals to spend at least 80 percent of premiums on medical care or other quality initiatives, according to the report.
6. In addition to Blue Shield of California, six other health insurance companies operating in the state owed policyholders money this year, though none owed more than a few hundred thousand dollars, according to the report. UnitedHealthcare owed policyholders more than $318,000, and U.S. Behavioral Health Plan, also known as OptumHealth, owed consumers $326,000.
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