NASHVILLE (AP) - More than 336,000 Tennessee residents will split $10 million in refunds from health insurance companies because of a provision in the Affordable Care Act.

The Tennessean reported (tnne.ws/WIRqs7) the refunds will average $53 per family and came about because of the medical loss ratio rule in the law. That provision requires insurers to spend at least 80 percent of insurance premiums on patient care and quality improvement efforts. The refunds are for premiums paid in 2013.

For 2012, refunds to Tennesseans totaled $5.6 million.

The actual total for refunds in Tennessee is $10,037,932.

"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," said Health and Human Services Secretary Sylvia M. Burwell.

News of the refunds comes after three advocacy groups filed a class action lawsuit on Wednesday accusi ng the state of Tennessee of failing to provide certain services required by the federal health care law.

The lawsuit by the Southern Poverty Law Center, the Tennessee Justice Center and the National Health Law Program follows a letter from the Centers for Medicare and Medicaid Services that was sent to state officials last month, accusing them of failing to meet requirements under the health care law.

The lawsuit says the state isn't providing in-person assistance and is forcing applicants to apply for TennCare - the state's expanded Medicaid program - through the federal Health Insurance Marketplace website, which was not designed for that purpose.

The lawsuit also accuses the state of failing to let people know within 45 days if they're eligible for Medicaid and doesn't provide a hearing if there's a delay in the eligibility decision.