Can someone please explain how private health insurance companies still paid rebates even though Covid negatively impacted the healthcare industry?

So in an article I read it in the KFF it said that in 2021 private health insurance companies paid out 1.5 billion in rebates. How can this be when there is much less money coming in bc of the coronavirus(less doctor visits bc of fear and etc…).

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So in an article I read it in the KFF it said that in 2021 private health insurance companies paid out 1.5 billion in rebates. How can this be when there is much less money coming in bc of the coronavirus(less doctor visits bc of fear and etc…).
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