Missouri’s biggest individual insurer must rebate almost $90 million to policyholders because it spent too little on care and too much on administration. Letters dated Sept. 10 notifying policyholders of the rebates — equal to more than one month’s premium for each — began arriving in mailboxes over the weekend. The rebates from Ambetter are among the largest for individual insurance companies operating in the Missouri marketplace since the Affordable Care Act began requiring them in 2012. Over 12 years, insurers have rebated $587.1 million to Missouri policyholders, with the most being $192.7 million in 2019. Every year, insurers must report their revenue from premiums and spending on health care and activities intended to improve care, such as smoking cessation or other programs.