Congratulations, Pennsylvania businesses and residents. Youve just been handed $51.5 million, courtesy of the federal Affordable Care Act.

The health care reform law requires insurers to rebate money spent on excess administrative costs. But even as checks arrived in the mail and credits appeared on statements, the rules governing how the money can be spent are hazy.

Companies received rebates through the beginning of this month in the form of checks or credits toward future premiums. In Pennsylvania, rebates for individuals averaged $238. Statewide, rebates totaled $345,669 for small businesses and $30.5 million for large employers.

Three midstate health insurance heavyweights Capital BlueCross, Highmark and Geisinger Health Plan didnt issue rebates. HealthAmerica reported that it did not issue rebates to customers in HMO and in-area PPO plans but did to out-of-area PPO and individual plans underwritten by parent company Coventry Health and Life Insurance Co.

Highmark has historically operated its business very efficiently, said Vik Mangalmurti, vice president of Highmarks office of health care reform.

Under the ACA, health insurers are required to spend at least 80 percent of revenue from premiums paid by individuals and small employers, or 85 percent from large employers, on health-related benefits. The law defines small employers as those with up to 100 people, although Pennsylvania took the federal option allowing states to set it at 50 or fewer.

Insurers that exceeded the maximum allowed for administrative costs an amount that depended on how many workers were being insured had to rebate a prorated share of the total excess to customers. Administrative costs include salaries, marketing and fraud prevention.

Businesses that receive rebates must, in essence, return the money to employees either outright or through such efforts as wellness programs.

Employers have 90 days after getting the money to decide what to do, but Vince Phillips, lobbyist for the Pennsylvania Association of Health Underwriters in Hampden Twp., said its not clear-cut.

I feel so sorry for employers right now. I really do, Phillips said. Theyve got to try to rebuild their economy, and now theyve got to figure out a labyrinth of federal rules.

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Health care law calls for rebates, but is vague on where they go and how they're spent