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Newsletter Article


Final Regulation on Medical Loss Ratio Reporting and Rebates

The U.S. Department of Health and Human Services (HHS) recently issued final regulations governing the Affordable Care Act's medical loss ratio (MLR) requirements on the percentage of enrollees' premiums health plans spend on medical care versus administration and profits. In a blog post, The Commonwealth Fund's Sara R. Collins, Ph.D., and Tracy Garber present an analysis of the rule, which requires plans in the large-employer group market that spend less than 85 percent of their premiums on medical care and quality improvement activities, and plans in the small-employer group and individual markets that spend less than 80 percent on the same, to offer rebates to enrollees. HHS estimates that in 2012, up to 9 million people might be eligible for rebates worth from $600 million to $1.4 billion.

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