Wichita ? Federal health care regulators have rejected a request from Kansas for a waiver of regulations on the amount of money insurance companies must earmark for health care.

The Wichita Eagle reported that the Department of Health and Human Services on Wednesday denied Kansas’ request regarding the amount of premiums that individual and small-group insurance companies must spend on health care and improving health care.

A provision of the 2010 federal health care act requires companies to spend 80 cents of every dollar on health care activities. The law requires companies that fail to meet that mark to make rebates to policyholders. Companies that provide coverage to groups of 50 or more must spend 85 percent of premiums on health care.

Kansas Insurance Commissioner Sandy Praeger said the state sought the adjustment to prevent damage to the insurance market.

Four companies, Coventry, Humana, Time and Golden Rule, may have to provide rebates this year.

“Whenever you’re implementing new policies that can potentially have a negative impact, you don’t want to leave any stone unturned,” Praeger said.

Praeger said she agreed with HHS that the insurance companies didn’t prove that the rule would be harmful and that Kansas wasn’t likely to appeal the decision announced Wednesday. HHS also denied a request from Oklahoma.

Steven Larsen, director of the Center for Consumer Information and Insurance Oversight in HHS, said that any company doing business in Kansas that didn’t meet the 80-20 rule in 2011 would have to give rebates to its customers this August. Using numbers from 2010, Larsen said about 35,000 people would be owed $6 million.

The rule took effect in 2011 and Larsen said the amount of rebates may not be that high because companies have been working to comply with the rule.

Larsen said the government has already seen benefits of the requirement in states where companies have changed their business models.

“Insurance consumers will get lower premiums” because of it, he said.

According to HHS, Coventry spent 72.6 percent on health care, Humana 70.8 percent, Time 68 percent and Golden Rule 62 percent. He said those companies are profitable and could afford to pay the rebates.

Four other companies, Blue Cross Blue Shield of Kansas, Blue Cross Blue Shield of Kansas City, Aetna and Reserve all were at or above the 80 percent level. The provision allows 20 percent of premium dollars to be spent on administrative costs, including marketing, advertising and agents’ commissions.

Praeger said some the companies will be able to prove that some of the administrative costs do improve health care and will be able to receive credit for the expense.

Larsen said one way companies could meet the mandate would be to cut agent commissions, but he said the federal agency didn’t have any evidence that would hurt access to insurance.

“We value the role agents play,” he said.