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Medical Loss Ratios
Government Resources
Analysis
Government Resources
Medical Loss Ratio website, Center for Consumer Information & Insurance Oversight (CCIIO)
CMS has issued two reminder memos concerning medical loss ratio requirements. One memo reminds health insurance issuers to file their first annual medical loss ration report to the government by June 1, 2012. The second memo reminds issuers to provide rebate notices to enrollees who are owed rebates from the 2011 MLR reporting year by August 1, 2012. 5/15/12 (New)
CMS published a final rule amending the regulations implementing medical loss ratio (MLR) standards for health insurance issuers. 5/11/12 (New)
The CCIIO has released additional technical guidance on the medical loss ratio (MLR) regulations. The guidance covers a variety of topics including the applicability of the rules to certain types of plans, the form of rebates and state MLR requirements. 4/20/12 (New)
HHS issued a memo to all insurance companies explaining how health insurance issuers should submit their Medical Loss Ratio (MLR) data as required under the Affordable Care Act. The report for the 2011 MLR reporting year must be filed by June 1, 2012. The memo describes who must file MLR reports, how to file, and when to file. 3/30/12
HHS released proposed insurer notices for consumers about whether the insurance companies have met the new standard. For text of the proposed notices, visit: http://cciio.cms.gov/resources/other/index.html#mlr and look under the "Medical Loss Ratio Forms" heading. 2/16/12
The Centers for Medicare & Medicaid Services (CMS) issued final regulations on the Medical Loss Ratio (MLR) provisions of the ACA. These final rules modify and clarify the rules that took effect on January 1, 2011. Some of the modifications include: making the MLR rebates tax fee to workers, providing consumers with an explanation of the MLR and rebates, and phasing down the adjustments for mini-med plans. The new rules are effective January 1, 2012.
Private Health Insurance: Early Indicators Show That Most Insurers Would Have Met or Exceeded New Medical Loss Ratio Standards, Government Accountability Office (GAO), 10/31/11
Consumers can check on rate increases (and medical loss ratios in 2012) for specific insurance companies at this website: Your Insurance Company & Rate Increases. 10/7/11
Private Health Insurance: Early Experiences Implementing New Medical Loss Ratio Requirements, Government Accountability Office (GAO), 7/29/11
CCIIO Technical Guidance: Questions and Answers Regarding the Medical Loss Ratio Interim Final Rule, 7/18/11
CCIIO Technical Guidance (CCIIO 2011—002): Questions and Answers Regarding the Medical Loss Ratio Interim Final Rule, 5/13/11
Maine is granted first state medical loss ratio waiver, CCIIO, 3/8/11
New regulations issued by the Department of Health and Human Services (HHS) require health insurers to spend 80 to 85 percent of consumers’ premiums on direct care for patients and efforts to improve care quality. This regulation, known as the “medical loss ratio” provision of the Affordable Care Act outlines disclosure and reporting requirements, how insurance companies will calculate their medical loss ratio and provide rebates, and how adjustments could be made to the medical loss ratio standard to guard against market destabilization. The IRS granted temporary relief to certain Blue Cross or Blue Shield organizations, and certain other organizations faced with implementing the medical loss ratio in IRS Notice 2010-79.
Analysis
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