A medical loss ratio (MLR) is the percentage of insurance premium dollars spent on health care claims.
Beginning on January 1, 2011, insurance companies will be required to report the proportion of premium dollars spent on clinical services and other costs. If an insurer does not meet the minimum medical loss ratio, the company will be forced to refund the difference to policyholders.
For large group plans, the minimum medical loss ratio is 85%. For small group and individual plans, the minimum medical loss ratio is 80%.
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Disclaimer: The information provided on this website is general in nature and does not apply to any specific U.S. state except where noted. Health insurance regulations differ in each state. See a licensed agent for detailed information on your state. PeopleKeep, Inc., does not sell health insurance.