Your Compliance Edge

Medical Loss Ratio (MLR) Rebates and Employer Responsibilities

Under the Affordable Care Act, insurers must spend a minimum percentage of the money they receive from health insurance premiums on medical care and quality improvement activities. This percentage is called a medical loss ratio (MLR). Insurers that offer health care coverage to individuals or small groups (usually not more than 50 employees) generally must meet an 80% MLR; for the large group market (usually more than 50 employees) the MLR is 85%. States can require a higher MLR.

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