Legal Alert: Medical Loss Ratio Interim Final Rule Released

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On December 1, 2010, the Department of Health and Human Services (HHS) published its interim final regulation implementing Medical Loss Ratio requirements for health insurance issuers under the health care reform law. The Medical Loss Ratio (MLR) requirements generally provide that beginning January 1, 2011 health insurance companies in the group and individual markets are required to spend at least 80% of premium dollars on medical care and quality improvement activities. Large group health care plans will be required to spend at least 85% of premium dollars on medical care and quality improvement activities. This is referred to as the MLR standard. Insurers offering coverage in a state with a higher MLR standard must meet that state's requirement.

Insurance companies must submit a report to HHS for each state in which the company is licensed to issue coverage that includes the experience of all policies issued during the MLR reporting year (i.e., calendar year.) The report will aggregate data separately for the large group policies, small group policies and individual policies at the state level. Certain exceptions are made for mini-med plans and policies that have been effective for less than the MLR reporting year. The report must be submitted no later than June 1 after the MLR reporting year and will reflect whether or not the health insurance issuer has met the applicable MLR standard.

Please see full alert below for more information.

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