Your Source for Health Reform

Topic: Medical Loss Ratio



The ACA’s MLR provisions require insurance companies to spend at least 80% to 85% of premium dollars on medical care, and to provide rebates to consumers when they fail to do this. Insurers are required to report data to the government to show that they are not spending too much on administrative costs.


ACA Provisions for Small Businesses

This roundup from the Small Business Administration details key provisions of the Affordable Care Act for employers with fewer than 25 employees, with links to essential FAQs, fact sheets, temporary guidance documents, and final rulings, published in the Federal Register. Topics covered include the SHOP, Small Business Tax Credit, employer notices to employees, medical loss ratio rebates, and other aspects of ACA implementation.

Medical Ratio Rebate Toolkit

Under a popular ACA provision, “medical loss ratio” rebates, insurers must return money to consumers if a health they didn’t spend enough on actual health care costs. Community Catalyst created and updates this MLR toolkit to help advocates publicize and message this important part of the ACA.

Estimating the Impact of the Medical Loss Ratio Rule

This 2012 state-by-state analysis by the Commonwealth Fund gives the estimated rebates for each state had the rule been in effect a year earlier. The ACA’s MLR rule requires insurers to pay out at least 80%-85% of premium dollars for medical care expenses.

Medical Loss Ratio in Illinois – SB 1618

This March 2010 from the Illinois Department of Insurance describes SB 1618, which was designed to bring Illinois law into conformity with one of the core consumer protections established by the Affordable Care Act.

Medical Loss Ratio Rebates: 2012 Estimates

In April 2012 the Kaiser Family Foundation estimated the amount in rebates consumers and employers could expect to receive that year, by state and market segment.

Explaining the Medical Loss Ratio

This March 2012 fact sheet from the Kaiser Family Foundation explains how the ACA’s MRL provision will affect health insurers and consumers. The provision requires most insurance companies that cover individuals and small businesses to spend at least 80% of their premium dollars on health care (that is, paying medical claims) and quality improvement. (more…)