About 5.5 million Americans will receive premium rebates averaging $129 per family from health insurers who did not meet medical loss ratio requirements in 2014, according to a new report by the Centers for Medicare & Medicaid Services. Under the Affordable Care Act, most individual and small group health plans must spend at least 80% and most large group plans at least 85% of premiums on direct medical care or quality improvement efforts annually or rebate the difference to policyholders. For more on the 2014 MLRs and refunds by state and market, visit www.cms.gov.