CRS details medical loss ratio requirements
Posted on September 27, 2012 | No Comments
The Congressional Research Service (CRS) published a report which outlines three issues on which legislation and hearings regarding the Affordable Care Act’s (ACA’s) medical loss ratio (MLR) requirement have focused. The issues include broker commissions, high-deductible health plans (HDHPs), and special rules for nonprofit insurers.
Under the MLR provision, individual and small group plans must spend at least 80 percent of premiums on medical benefits or activities to improve consumer health care quality. Large group plans must spend at least 85 percent. If plans do not meet this MLR requirement, they must refund the different to beneficiaries. In August 2012, insurance companies refunded $1.1 billion to approximately 12.8 million consumers for 2011, due to the ACA provision.
- Applicability of the Medical Loss Ratio to Certain Types of Plans
- Employer Groups of One
- Counting Employees for Determining Market Size
- Individual Association Policies
- Offering Policyholders a “Premium Holiday”
- Reinsurance and Reporting
- Exchange User Fees
- States With a Higher Medical Loss Ratio Standard
- “Mini-Med” Experience – Application of the Adjustment
- Form of Rebate