If you're wondering why Aetna just pulled out of Indiana here's a likely clue: Indiana Residents Could Receive $30M in Rebates as Payors Fail to Meet Healthcare Reform Requirements "Indiana residents purchasing individual health insurance are expected to receive $30 million in refunds as new rules from healthcare reform take effect this year, according to an Indiana Business Journal report. The estimated refund amounts were calculated for Indiana Insurance Commissioner Stephen Robertson's agency this month, based on health insurers' most recent annual filings, to determine how easily insurers could meet new guidelines that require them to spend at least 80 percent of premium revenue of medical bills. According to the review, only 19 of the 63 companies writing individual health insurance policies have historically met the 80 percent standard. The other 44 Indiana companies would have to distribute rebate checks to customers to make up the difference between their actual spending and the 80 percent requirement. According to the report, those 44 companies cover approximately 94 percent of the 200,000 Indiana residents with individual health insurance. Some companies are relatively close to the 80 percent threshold, including Indianapolis-based Anthem Blue Cross and Blue Shield, which spends 76.6 percent of premiums on medical bills. Others, such as Indianapolis-based Golden Rule Insurance, are further from the goal; Golden Rule spends approximately 64 percent of premiums on medical bills. "