AHIP weighs in on medical loss ratios
Posted on May 13, 2010 |
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Implementation Briefs
America’s Health Insurance Plans offers its perspective in a letter to the Health Reform Solvency Impact (E) Subgroup, which is charged with developing definitions and methodology for calculating medical loss ratios under the health reform law.
December 2, 2011
The U.S. Department of Health and Human Services (HHS) has issued an interim final rule (IFR), with public comment, on the medical loss ratio (MLR) requirement under the Affordable Care Act (ACA). Beginning in 2012, the ACA requires that health insurers spend at least 80% (in some cases 85%) of premiums on health care services, or be required to pay rebates to plan members. HHS issued both the rule itself as well as a separate IFR on the rebate requirements, each allowing for public comment.
For more information on medical loss ratios, click here. An update to the previous brief is pending.
November 23, 2010
This is an updated version of a brief originally published on August 25, 2010. This brief is current as of November 22, 2010.
A medical loss ratio (MLR) is the proportion of premium dollars that an insurer spends on health care services relative to health insurance premium paid by subscribers. Prior to the enactment of the health reform law, the federal government required Medicare supplemental insurance (or Medigap policies) to meet minimum federal loss ratio requirements, but did not establish federal standards to define how insurers should categorize losses, nor did those requirements apply to other types of private insurance policies.
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