2025 Medical Loss Ratio (MLR) Information

What is the Medical Loss Ratio rebate?

Competitive premiums and consumer-friendly products make Mass General Brigham Health Plan a popular choice for high-quality and affordable healthcare coverage. Mass General Brigham Health Plan is committed to delivering affordable products and an exceptional experience for our members. This year, Mass General Brigham Health Plan is rebating a portion of premium payments for eligible members and small employers.

Who will receive rebates for 2025?

Mass General Brigham Health Plan will provide rebates for fully insured plans offered to individuals and small employer groups with 1-50 employees (also called the merged market). For these plans, Mass General Brigham Health Plan's MLR of 87.7% was lower than the required threshold, so we are rebating the difference back to policy holders.

Rebates are not provided if the amount calculated is below the minimum dollar amount thresholds defined by the Federal government:

1. The total amount calculated for a group policyholder is less than $20, or
2. The total amount calculated for an individual subscriber is less than $5.

For large employer group plans, Mass General Brigham Health Plan met the minimum MLR percentage threshold, so no rebates are required.  

How will the rebates be provided?

Many of our small employers purchase their insurance directly through Mass General Brigham Health Plan. Small employers and individuals can also purchase their Mass General Brigham Health Plan insurance through intermediaries such as HSA Insurance (HSA) and the Small Business Service Bureau (SBSB) or through the Massachusetts Health Connector. Here is how rebates will be provided:

• Premium credits will be provided by Mass General Brigham Health Plan to small employer groups who purchase their coverage directly from Mass General Brigham Health Plan and are active clients. Rebate checks will be provided to small employers who purchase their coverage directly through us but terminated their coverage.
• Rebate checks will be provided by Mass General Brigham Health Plan to individuals and small employer groups who purchase their coverage through the Massachusetts Health Connector.
• Premium credits will be provided by the Small Business Service Bureau (SBSB) to individuals and small employer groups who purchase their coverage from SBSB and are active clients. Rebate checks will be provided by SBSB to individuals and small employers who purchase their coverage through SBSB but terminated their coverage.
• Premium credits will be provided by HSA Insurance (HSA) to individuals and small employers who purchase their coverage through HSA and are active clients. Rebate checks will be provided by HSA to individuals and small employers who purchase their coverage through HSA but terminated their coverage.

Can you share sample notices?

Yes. Here is a sample subscriber notice and a sample small employer group notice.

When will rebates be provided?

Rebates and notices will be sent by August 30, 2026.

Will subscribers be notified if their employers are receiving a rebate?

Yes. Subscribers whose employers are receiving a federal rebate will receive a notice in the mail postmarked by August 30, 2026.

What responsibilities does an employer have if they receive a rebate?

Employers may have fiduciary responsibilities regarding use of this MLR rebate. For general information on the usage of this rebate, you may contact the U.S. Department of Labor (DOL) at (866) 444-3272 or review their guidance on this issue in this document: https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/mlr-insurance-rebate.pdf. Employers also should consult with their benefit or legal advisor about this rebate.

Are employers who are not receiving a rebate getting notified?

No, only employers who will be receiving an MLR rebate for 2025 will be notified.

Could rebates affect taxes for employers and/or individuals?

Yes, rebates may have a tax impact both to employers receiving rebates and to individuals. You may want to consult with your financial and tax advisors regarding the tax impact of the rebate or contact the IRS at (800) 829-1040 or visit https://www.irs.gov/newsroom/medical-loss-ratio-mlr-faqs.