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Life Health > Health Insurance > Health Insurance

The Catch: MLR Rebate Accrual

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Assurant Inc. (NYSE:AIZ) swallowed hard and put information about its medical loss ratio (MLR) rebate payments in its earnings release for the fourth quarter of 2011.

Cigna Corp. (NYSE:CI) left the word out of its fourth-quarter earnings release, but company executives did provide a specific “MLR rebate accrual” number during an earnings call.

Assurant, New York — a company with a large mortgage insurance operation and an employee benefits business as well as a health insurance business — is reporting $162 million in net income for the latest quarter on $2.1 billion in revenue, compared with a net loss of $184 million on $2.1 billion in revenue for the fourth quarter of 2010.

The Assurant Health unit is reporting $23 million in net operating income on $446 million in net earned premiums, fees and others, compared with $15 million in net operating income on $471 million in net earned premiums, fees and others for the comparable quarter in 2010.

Operating income at the unit “benefited from disciplined expense management,” the company says.

The minimum MLR provisions in the Patient Protection and Affordable Care Act of 2010 (PPACA) now requires carriers to spend 85% of large group revenue and 80% of individual and small group revenue on health care and quality improvement efforts. Carriers that go under the thresholds are supposed to send rebates to the customers.

Assurant Health competes mainly in the individual and small group markets.

Earlier in the year, Assurant had warned that health unit earnings were being affected by efforts to set aside reserves for MLR rebate expenses.

Assurant Health believes it has a $42 million MLR rebate accrual, but the total is $6.8 million less the company had expected earlier in the year.

Cigna, Bloomfield, Conn., is reporting $290 million in net income on $5.5 billion in revenue, compared with $461 million in net income on $5.4 billion in revenue for the fourth quarter of 2010.

U.S. health plan enrollment held steady at about 11 million; international enrollment increased to 1.2 million, from 1 million.

During the Cigna earnings call, company executives estimated the company has accrued about $44 million in rebate expenses on an after-tax basis.

HE’S TOLD THEM SO (AGAIN)

Douglas Elmendorf, director of the Congressional Budget Office (CBO), tried to get the attentioElmendorfn of members of Congress today by noting, in testimony before the Senate Budget Committee, that rising health care costs are a serious problem.

“Under both CBO’s baseline and its alternative fiscal scenario, the aging of the population and rising costs for health care will push spending for Social Security, Medicare, Medicaid, and other federal health care programs considerably higher as a percentage of [gross domestic product] (GDP),” Elmendorf said, according to a written version of his remarks.

“If that rising level of spending is coupled with revenues that are held close to the average share of GDP that they have represented for the past 40 years (rather than being allowed to increase, as under current law), the resulting deficits will increase federal debt to unsupportable levels,” Elmendorf said. “To prevent that outcome, policymakers will have to substantially restrain the growth of spending for those programs, raise revenues above their historical share of GDP, or pursue some combination of those two approaches.”


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