An estimated 68,090 Hawaii residents will receive a combined $4.9 million in refunds from health insurance companies this year as a result of new requirements under the Affordable Care Act, the U.S. Department of Health & Human Services announced Thursday.

The refunds average $133 per family.

President Barack Obama’s signature health care law established the 80/20 rule, also known as the medical-loss ratio, requiring insurers spend at least 80 percent of premiums on patient care and quality improvement. Insurers that spend "an excessive amount on profits and red tape" must refund consumers the difference, HHS said.

"The 80/20 rule is bringing transparency and competition to the insurance market, ensuring that consumers are continuing to receive value for their premium dollars," Health and Human Services Secretary Sylvia Mathews Burwell said in a news release. "Standards like these created under the health care law are providing Hawaiians with immediate savings and are helping to keep costs down over the long-term."

The bulk of the refunds — $4.1 million — will come from Hawaii Management Alliance Association. The nonprofit health insurer will pay $2.3 million to small groups and $1.8 million to large employers.

"The reason why HMAA had significant refunds this year as well as past years is that we have a very good wellness program which helps on the number of claims and our claims administrators have done very good job at keeping costs down," said HMAA President Bill McCorriston. "We’re a very efficient organization, which ultimately is benefiting our members by reduced premiums. We have a lot of happy members at the end of the year."

The rule, for the most part, doesn’t affect Hawaii’s large insurers, including Hawaii Medical Service Association and Kaiser Permanente Hawaii, which typically spend well over 80 percent of premiums on medical benefits.

The only drawback to having refunds mandated under the ACA, according to McCorriston, is small insurance carriers can’t build up their reserves because a significant amount of profits must be rebated to members.

"The policy has good and bad," he said. "The good is members enjoy a refund but the bad is insurance companies can’t build up the reserves to be stronger as they had been able to in the past. We’re a nonprofit. What we’ve done with profits in the past is build up our reserves to protect our members."

HMAA’s reserves are about $11 million, he said.

Other Hawaii payments include American Specialty Health Insurance Co., which will refund $172,793; UnitedHealthcare Insurance Co., $616,075; and United States Life Insurance Co. in the City of New York will pay $3,440.

Nationwide, consumers have saved $9 billion on their health insurance premiums since the rule took effect, according to HHS. Last year alone, consumers saved an estimated $3.8 billion as a result of reduced premiums. Consumers nationwide will receive $330 million in refunds this year, with 6.8 million consumers due to receive an average national refund benefit of $80 per family.

"Since the standard took effect, more insurers year over year are meeting the 80/20 rule by spending more of the premium dollars they collect on patient care and quality, and not red tape and bonuses," HHS said.

Affected Hawaii residents will see a refund check in the mail, a lump-sum reimbursement to the same account used to pay their premiums, a reduction in future premiums or their employer using refunds to improve coverage.